Medical Management Plan Research Articles

Assessing Analgesic Adherence and Influencing Factors in Saudi Cancer Patients

Background: As cancer incidences rise within the Saudi population, effective pain management remains a critical component of oncological care. Analgesic adherence is vital for managing cancer-related pain, yet it is often inadequately addressed in clinical practice, leading to diminished quality of life of patients. Objectives: This study aimed to assess the level of adherence to analgesic medications among Saudi cancer patients and to identify demographic and health-related factors that may influence adherence. Methods: In a cross-sectional study at King Abdulaziz Medical City, 132 oncology patients were sampled randomly. Data were collected through an online survey incorporating demographic queries and the Morisky Medication Adherence Scale (MMAS-8). SPSS 26 facilitated the statistical analysis, with descriptive statistics and Spearman’s Rho tests determining the significance of the findings. Results: Among participants, 52.2% were married, 51.5% were unemployed, and 80.4% reported substantial social support. Health insurance was prevalent among 79.5% of patients. Low adherence was observed in 94.6% of patients, with only 0.8% showing high adherence. The primary reasons for non-adherence included forgetting (54.5%) and fear of side effects (38.6%). Age and the number of medications were significantly correlated with adherence levels, highlighting the multifactorial nature of medication adherence in this patient population. Conclusions: The research highlights a concerning level of low adherence to analgesics among Saudi oncology patients, suggesting an urgent need for targeted interventions. Strategies to improve adherence should focus on education regarding the importance of pain management and addressing patients' concerns about medication side effects and dependency, as well as personalized medication management plans to accommodate the complexities of handling multiple medications. These findings are instrumental for oncology healthcare providers to optimize pain management strategies and enhance patient outcomes.

A Review and Case Series of Uterine Lipoleiomyomata

Purpose: The purpose of this case series is to understand the prevalence, clinical significance, pathophysiology, pathology findings, and workup of uterine lipoleiomyomas. Methods: This case series, with cases in February and March of 2023, includes the presentation, clinical management, and pathologic diagnosis of two separate uterine lipoleiomyomas. Separate chart reviews were performed on each patient, including frozen and permanent section pathologic findings. Micropictographs were obtained from hematoxylin and eosin-stained slides. This project was acknowledged as “IRB-exempt” by the MU Institutional Review board. Results: Case 1: A 51-year-old G3P2 woman presented with six months of severe postmenopausal bleeding, severe left-lower quadrant pelvic pain, and lightheadedness. A transvaginal ultrasound revealed a heterogeneous, thickened endometrial echo of 3.9 centimeters and a probable left ovarian dermoid cyst. CT showed distension of endometrial cavity due to polyps and/or submucosal masses, as well as a fat-containing mass in the uterine corpus. Hysteroscopy with dilation and curettage was performed with pathology of high-grade malignancy. Differential diagnosis at this time included high-grade stromal sarcoma, undifferentiated carcinoma, adenosarcoma, or malignant mixed Mullerian tumor. Patient underwent MRI due to concern for malignancy, which showed FDG-avid endometrial thickening with no other FDG-avid areas of concern. Histopathologic diagnosis found carcinosarcoma of the uterus, two positive lymph nodes, and an incidental finding of lipoleiomyoma. Plan for medical management with gynecologic oncology will include chemotherapy and vaginal cuff brachytherapy for uterine carcinosarcoma. Case 2: A 50-year-old G5P5 woman presented with increasing vaginal spotting and worsening urge incontinence. CT showed increased size of heterogeneous mass in right lateral uterine wall, consistent with previously identified fibroid/leiomyoma. An adjacent fat-containing lesion was identified within the uterine wall. Patient underwent MRI which revealed large uterine mass at the fundus, with an associated fatty component. Due to the abnormal rate of fibroid growth, and the fat component, there was concern for uterine sarcoma and/or malignant transformation of leiomyoma. Histopathologic diagnosis found lipoleiomyoma with benign atrophic endometrium, paratubal cysts of bilateral fallopian tubes, and follicular cyst of the right ovary. Follow-up in one year was recommended. Conclusion: Lipoleiomyomas are uncommon benign entities, occurring most commonly in postmenopausal women, similarly to uterine fibroids. While asymptomatic patients can be managed conservatively, these tumors can cause vaginal bleeding, pain, and urinary or fecal incontinence and can be definitively treated with hysterectomy. While imaging is necessary to initially characterize the lesion and determine concern for malignancy, histopathologic diagnosis remains the gold standard for diagnosis. Lipoleiomyomas are associated with other gynecologic malignancies, metabolic disorders, and rarely tumor-to-tumor metastasis. For this reason, careful clinical evaluation and surgical management are required for complete evaluation of the patient.

579-P: ADA Diabetes Medical Management Plan Implementation—Barriers and Opportunities

579-P: ADA Diabetes Medical Management Plan Implementation—Barriers and Opportunities

A nurse driven care management program to engage older diabetes patients in personalized goal setting and disease management.

Multiple diabetes care guidelines have called for the personalization of risk factor goals, medication management, and self-care plans among older patients. Study of the implementation of these recommendations is needed. This study aimed to test whether a patient survey embedded in the Electronic Healthcare Record (EHR), coupled with telephonic nurse care management, could engage patients in personalized goal setting and chronic disease management. We conducted a single-center equal-randomization delayed comparator trial at the primary care clinics of the University of Chicago Medicine from 2018.6 to 2019.12. Patients over the age of 65 years with type 2 diabetes with an active patient portal account were recruited and randomized to receive an EHR embedded goal setting and preference survey immediately in the intervention arm or after 6 months in the delayed intervention control arm. In the intervention arm, nurses reviewed American Diabetes Association recommendations for A1C goals based on health status class, established personalized goals, and provided monthly telephonic care management phone calls for a maximum of 6 months. Our primary outcome was the documentation of a personalized A1C goal in the EHR. A total of 100 patients completed the trial (mean age, 72.51 [SD, 5.22] years; mean baseline A1C, 7.14% [SD, 1.06%]; 68% women). The majority were in the Healthy (59%) followed by Complex (30%) and Very Complex (11%) health status classes. Documentation of an A1C goal in the EHR increased from 42% to 90% (p < 0.001) at 6 months in the intervention group and from 54% to 56% in the control group. Across health status classes, patients set similar A1C goals. Older patients can be engaged in personalized goal setting and disease management through an embedded EHR intervention. The clinical impact of the intervention may differ if deployed among older patients with more complex health needs and higher glucose levels. ClinicalTrials.gov Identifier: NCT03692208.

Coordination of oral anticoagulant care at hospital discharge (COACHeD): pilot randomised controlled trial

ObjectivesTo evaluate whether a focused, expert medication management intervention is feasible and potentially effective in preventing anticoagulation-related adverse events for patients transitioning from hospital to home.DesignRandomised, parallel design.SettingMedical wards at...

Partnered pharmacist medication charting and prescribing in Australian hospitals.

Medication charting and prescribing errors commonly occur at hospital admission and discharge. Pharmacist medication reconciliation, after medicines are ordered by a medical officer, can identify and resolve errors, but this often occurs after the errors have reached the patient. Partnered pharmacist medication charting and prescribing are interprofessional, collaborative models that are designed to prevent medication errors before they occur, by involving pharmacists directly in charting and prescribing processes. In the partnered charting model, a pharmacist and medical officer discuss the patient's current medical and medication-related problems and agree on a medication management plan. Agreed medicines are then charted by the pharmacist on the inpatient medication chart. A similar collaborative model can be used at other points in the patient journey, including at discharge. Studies conducted at multiple Australian health services, including rural and regional hospitals, have shown that partnered charting on admission, and partnered prescribing at discharge, significantly reduces the number of medication errors and shortens patients' length of stay in hospital. Junior medical officers report benefiting from enhanced interprofessional learning and reduced workload. Partnered pharmacist medication charting and prescribing models have the best prospect of success in environments with a strong culture of interprofessional collaboration and clinical governance, and a sufficiently resourced clinical pharmacist workforce.

A Challenging Conundrum; Learning Disability, Schizophrenia and Autism - a Case Report

IntroductionPsychiatric disorders are common in patients with learning disabilities. There are also patients with the triad of autism, schizophrenia and learning disability. Patients with this background can be admitted to general hospitals for psychiatric or non-psychiatric reasons.We are presenting a case who had a very complicated clinical course and her discharge planning was challenging.ObjectivesThe objective of this work was to show the challenges in the investigation, medical management, and discharge planning of the patients with concomitant learning disability, schizophrenia and autism.MethodsWe scrutinized the patient’s casenotes, including blood results and all relevant imaging. We paid a particular attention to all the entries from the psychiatry team, general medical doctors, oncologists, learning disability team and discharge planners.ResultsThe lady had a protracted 4-month inpatient admission throughout which she was physically and verbally aggressive to hospital staff. She was deemed to lack capacity for hospital admission and treated in her best interests under Mental Capacity Act (MCA), frequently requiring sedation with Haloperidol and Lorazepam. Following consultation with the local Psychiatrist her medications were altered to: Risperidone 2 mg BD, Diazepam 5 mg OM, 5 mg afternoon and 10 mg evening, Procyclidine 5 mg BD, Chlorpromazine 25 mg BD, Promethazine 25 mg OD PRN, and Midazolam 10 mg buccal PRN.A change in her clinical condition was noted by the Psychiatry team; increased agitation, confusion and dysarthria. A repeat blood test was advised, due to patient refusal this took weeks to achieve despite the use of buccal Midazolam following Anaesthesiologist advice. Although blood tests were not significantly deranged, she was treated for presumed urinary tract infection with a course of antibiotics. A urine sample was unobtainable.She reported right breast pain and underwent a mammogram. This showed a hypoechoic lesion 8x7x9 mm. Following consultation with a Breast Surgeon and Oncologist, Letrozole was replaced with Tamoxifen. The Psychiatric team concluded that the clinical deterioration with dysarthria was related to anxiety, associated with Autistic patients. The movement disorder was deemed secondary to antipsychotics exacerbated by stress and anxiety.The patient’s discharge planning was complex. She was declined by numerous care homes. At time of writing, she remains an inpatient.ConclusionsThe management of patients with a triad of Learning Disability, Schizophrenia and Autism is extremely difficult, particularly within an acute medical setting. Physical deterioration could be related to medication adverse effects or change in environment. Anxiety and stress are linked to these conditions. The challenging behaviour that these patients often have will make discharge planning very difficult as specialised care homes to accommodate these unique patients are very limiteDisclosure of InterestNone Declared

Abstract 13467: Artificial Intelligence Guided Coronary CT Angiography Impacts Care Beyond Conventional Assessment: The CERTAIN Trial

Background: Atherosclerosis imaging-quantitative CT angiography (AI-QCT) guided by artificial intelligence has demonstrated high diagnostic accuracy for assessment of coronary atherosclerosis, stenosis and ischemia (AI-QCT ISCHEMIA ). Methods: CERTAIN was a multicenter study in 5 expert US centers prospectively recruiting 775 consecutive adult patients referred for CCTA. First, physicians were asked to complete an assessment of the patients’ diagnosis, additional imaging plan, intervention plan and medication management plan based on the conventional site assessment. Subsequently, coronary CT angiography (CCTA) exams were analyzed using AI-QCT, after which physicians were asked to repeat the assessment. Results: The 775 patients had a mean age of 64±12 years, 304 (39%) were female. Compared to site CCTA, AI-QCT analysis improved physician’s complete confidence two- to fivefold in every step of the care pathway (Figure). Overall, AI-QCT was associated with at least one clinical category change in over half (389; 50.2%) of patients compared to site CCTA interpretation, including CAD-RADS (304; 39.2%) and plaque burden (194; 25.2%). With implementation of AI-QCT, there was a 67% (43 vs. 14; p &lt;0.001) reduction in patients planned for myocardial perfusion imaging and a 48% (163 vs. 85; p &lt;0.001) reduction in patients referred for PCI or CABG compared to site CCTA. Conclusion: Implementing AI-QCT enabled a single-modality triple-aim assessment of stenosis, quantitative atherosclerosis and ischemia assessment through CCTA that improved physicians’ confidence, enhanced preventive medication uptake while it reduced the need for perfusion imaging and invasive testing.

The Connection Between Chronic Illness and Physical Activity

Chronic diseases have become a focal point of public health worldwide with estimates of trillions of dollars in annual health care cost and causing more than 36 million deaths a year. Lifestyle factors such as physical inactivity are heavily correlated with the development of many chronic diseases. New strategies for primary and secondary disease prevention are desperately needed to aid in blunting the negative economic and social impact of these diseases. Physical activity (PA) and exercise are now considered principal interventions for use in primary and secondary prevention of chronic diseases. Currently, more emphasis in primary prevention of disease is necessary to reduce disease risk in youth and adults; however with chronic disease prevalence so high, similar emphasis is also necessary for secondary prevention in those children and adults already inflicted with chronic diseases. Conditions such as cardiovascular disease, type 2 diabetes, obesity, and cancer are drastically improved when PA and exercise are part of a medical management plan. In addition, the national PA guidelines in conjunction with PA promotion tools like Exercise is Medicine™ are needed to promote increased PA and exercise levels worldwide

Cancer-related post-treatment pain and its impact on treatment satisfaction with medication in women with breast cancer: a cross-sectional study from Palestine.

Pain after therapy is an important clinical problem in patients with breast cancer. Unfortunately, cancer patients have a lower quality of life due to inadequate treatment of posttreatment pain; therefore, improving medication management plans and palliative care has become one of the most important targets of cancer therapy. Therefore, the current study aimed to examine the impact of posttreatment pain on medication satisfaction in patients with various stages of breast cancer in Palestine. A cross-sectional analytical study was conducted et al.-Watani Hospital and An-Najah National University Hospital in the Nablus area. Using the Brief Pain Inventory (BPI), the intensity and interference of pain were evaluated. In addition, patients' satisfaction with cancer management medications was measured using the Treatment Satisfaction Questionnaire for Medication (TSQM). Two hundred fifty-four patients were included in this study. All were women, with a mean ± SD age of 53.1 ± 10.7years. The median score for pain severity was 7.0. Pain in the lower extremities was the most reported location. There was a negative association between the global satisfaction domain and the presence of posttreatment pain (p < 0.001). Furthermore, significant differences and negative correlations were found between global satisfaction and posttreatment pain on the day of the interview (p = 0.001), pain medication (p < 0.001), paracetamol use (p < 0.001), and the presence of side effects (p = 0.003). There were significant negative correlations (p < 0.05) between pain severity and interference with effectiveness (r = -0.258, -0.319, respectively), side effects (r = -0.414, -0.514, respectively), convenience (r = -0.274, -0.307, respectively), and global satisfaction domain scores (r = -0.293, -0.287, respectively). Exposure to chemotherapy was the only significant positive correlation with global satisfaction (p = 0.007). The regression analysis results indicated an independent association between chemotherapy use and a higher global satisfaction score (p = 0.011). Patients with posttreatment pain, side effects, and greater interference of pain with their functioning had lower satisfaction scores. Therefore, better management of their treatment medications, side effects, and pain medications is recommended to enhance their satisfaction and quality of life. Several aspects of palliative care should be organized to improve the patient's satisfaction and quality of life in addition to conducting longitudinal studies to evaluate the pain and satisfaction of different types of cancers.

Postdischarge Video Visits for Adherence to Hospital Discharge Recommendations: A Randomized Clinical Trial

ObjectiveTo determine whether a postdischarge video visit with patients, conducted by hospital medicine advanced practice providers, improves adherence to hospital discharge recommendations. Patients and MethodsWe conducted a single-institution 2-site randomized clinical trial with 1:1 assignment to intervention vs control, with enrollment from August 10, 2020, to June 23, 2022. Hospital medicine patients discharged home or to an assisted living facility were randomized to a video visit 2-5 days postdischarge in addition to usual care (intervention) vs usual care (control). During the video visit, advanced practice providers reviewed discharge recommendations. Both intervention and control groups received telephone follow-up 3-6 days postdischarge to ascertain the primary outcome of adherence to all discharge recommendations for new and chronic medication management, self-management and action plan, and home support. ResultsAmong 1190 participants (594 intervention; 596 control), the primary outcome was ascertained in 768 participants (314 intervention; 454 control). In intervention vs control, there was no difference in the proportion of participants with the primary outcome (76.7% vs 72.5%; P=.19) or in the individual domains of the primary outcome: new and chronic medication management (94.1% vs 92.8%; P=.50), self-management and action plan (76.5% vs 71.5%; P=.18), and home support (94.1% vs 94.3%; P=.94). Women receiving intervention vs control had higher adherence to recommendations (odds ratio, 1.77; 95% CI, 1.08-2.91). ConclusionIn hospital medicine patients, a postdischarge video visit did not improve adherence to discharge recommendations. Potential gender differences in adherence require further investigation.Clinicaltrials.gov number, NCT04547803.

Addressing the healthcare waste management barriers: A structural equation modeling approach.

Due to the growing population and advancing economy, medical waste accumulation has come to the attention of all facets of society. Although the issue of medical waste management planning has been addressed in developed nations, it still exists in several developing nations. This paper examines the effects of barriers under the Organization action, work handling, and Human Resource Practices section on the healthcare waste management (HCWM) sector in a developing country India. In this study, three hypotheses were constructed and tested using Structural equation modeling. The questionnaire was distributed among 200 health professionals to collect their responses. Ninety-seven responses were received, and 15 barriers were identified affecting the healthcare waste management sector. The results show that all three barriers (i.e., Organizational, Waste handling, and Human resources) hinder the Healthcare waste management sector. Organizational Barriers are the most significant among other barriers. So, the hospitals have to take appropriate actions to overcome these barriers. This paper helps to complete the research gap by providing the different characteristics of barriers. The development of a model for the analysis of barriers influencing HCWM is the Author's original contribution.

Infectious healthcare waste management among private dental practitioners in the Rabat-Salé-Kénitra region, Morocco: A cross-sectional study on knowledge, attitudes, and practices.

The increase in dental healthcare facilities and the use of single-use equipment have increased the production of healthcare waste. Their mismanagement exposes healthcare workers, waste managers, and the population to an infectious risk and negatively impacts the environment. Therefore, a correct management procedure has to be adopted from separation through storage to disposal. This study aimed to investigate dentists' knowledge, attitudes, and practices regarding managing infectious healthcare waste in private dental offices. A descriptive and analytical cross-sectional survey was conducted between December 2020 and March 2021 among private dentists registered at the Moroccan National Council of Dentists in the Rabat-Salé-Kénitra region. A questionnaire was developed to assess waste management in dental offices. Of the 500 questionnaires distributed, 190 completed and exploitable questionnaires were collected. Only 27.3% of healthcare waste managers in dental practices received training, 21,5% of practitioners assimilated the used gloves into household waste, 71.5% disposed of the waste generated by their offices directly into public bins, and 86.4% were unaware of Moroccan law 28-00 on waste management and disposal. This study highlights dentists' apparent lack of knowledge regarding healthcare waste management, and significant gaps were identified between actual practices and recommended regulations. To address these issues, developing a comprehensive medical waste management plan is crucial to encourage the practical cooperation of all stakeholders in this sector.

Strategi Pengelolaan Limbah Padat Infeksius di Rumah Sakit Ibu dan Anak Family Jakarta Utara

The hospital is a health service that produces various infectious wastes that can endanger the officers who handle the waste and visitors and the community around the hospital. The purpose of the study was to determine the performance of infectious solid waste management at the Family Mother and Child Hospital, to determine the internal and external factors in the management of infectious solid waste at the Family Mother and Child Hospital, and to obtain the formulation of infectious solid waste management strategies at the Mother's Hospital. and Child Family. This research was conducted at the Mother and Child Family Hospital, North Jakarta, related to infectious solid waste management strategies. Data collection methods used are interviews, focus group discussions (FGD) and questionnaires. To get the main priority strategy using the IFE- EFE- IF- SWOT matrix. Research Results Based on the analysis of the QSPM matrix, there were 6 strategies that could be prioritized based on the highest ranking, namely (1) Implementing infectious solid waste management systems and procedures in a professional manner, (2) Improving the quality and competence of officers to prevent environmental pollution, (3) Conducting periodic socialization/training to employees related to infectious solid waste management, (4) Preparing medical waste management plans in accordance with the standards of the Minister of Health, (5) Providing sanctions to employees who do not follow the rules in handling infectious solid waste, (6) Optimizing the budget in infectious solid waste management. Keywords: Infectious Solid Waste Management Strategy

Abstract #1406325: The Complexities of Managing Hypertriglyceridemia-Induced Pancreatitis in a Critically-Ill COVID-19 Patient

Hypertriglyceridemia-induced pancreatitis (HTP) is a variant of pancreatitis requiring unique management. The complications of COVID-19 and its treatments can make HTP therapy more nuanced. This case describes a patient who presented in diabetic ketoacidosis (DKA) with HTP, and COVID-19. The patient developed renal and respiratory failure, necessitating hemodialysis (HD) and extracorporeal membrane oxygenation (ECMO), complicating an otherwise straightforward medical management plan. A morbidly obese (BMI 38.9 kg/m2) 43-year-old male presented to an outside hospital with abdominal pain, and vomiting, and was found to have HTP with triglycerides (TG) >2000 mg/dL (<149 mg/dL) and presumed new-onset type 2 Diabetes (HbA1c 10.9%) with DKA. Treatment with fluids, intravenous (IV) insulin infusion and plasmapheresis were initiated. He developed hypoxia after receiving over 17 liters of fluids and was intubated, subsequently developing renal failure and was transferred to our tertiary center for HD and ECMO. On admission, he tested positive for COVID-19, rhabdomyolysis [creatinine kinase 5600 U/L (30-200 U/L)], HTP [TG 783 mg/dL (<149 mg/dL), lipase 461 U/l (7-60 U/L)], glucose 269 mg/dL (not in DKA), transaminitis [AST 184 U/L (4-40 U/L), ALT 61 U/L (4-41 U/L)] and renal failure (GFR 10 ml/min/1.73m2). IV insulin infusion was initiated for hyperglycemia worsened by COVID-19 dexamethasone treatment. Plasmapheresis was performed twice with minimal effect at maintaining a low TG. Fenofibrate was not initiated due to renal failure; Lovaza could not be given via oral gastric tube; Atorvastatin was attempted once rhabdomyolysis resolved, with subsequent worsening of liver function tests. Heparin infusion was initiated for deep vein thrombosis treatment and HTP but was stopped after development of heparin induced thrombocytopenia. The patient developed worsening hypoglycemia requiring cessation of IV insulin, hypotension requiring maximum pressor support, and worsening sepsis leading to his death. This case illustrates the challenges of managing a patient with HTP and COVID-19. It demonstrates how a normally straightforward treatment algorithm can become increasingly complex when factoring the patient’s comorbid conditions. The case highlights the importance of knowing both treatment indications and contraindications for HTP. In this case, HTP may have been the initial diagnosis, straightforward for most endocrinologists, but its treatments and comorbid conditions ultimately made the landscape more challenging, limiting effective management and ultimately leading to this patient’s demise.

Pharmacist Role in Hypertension Management in the Community Setting: Questionnaire Development, Validation, and Application.

Hypertension is a leading cause of mortality and morbidity globally. Pharmacists can play a substantial role in decreasing the burden of the disease. The primary aim of this study was to develop and validate a scale assessing the pharmacist role in hypertension management in the community pharmacy setting. The secondary aims were to assess the services/interventions in hypertension management that were performed in the real-life setting, as well as the patient satisfaction from these services/interventions. This cross-sectional study was conducted in Egypt. The data were collected using a survey composed of three sections: a general section, the pharmacist role questionnaire section, and the patient satisfaction from the provided interventions/services section. The pharmacist role questionnaire was developed based on the pharmaceutical care practice conceptual model and included 23 questions. The face validity, content validity, reliability testing using Cronbach alpha, and construct validity using exploratory factor analysis were determined. The percentage of the frequency by which each role was reported to be performed was determined. Patient satisfaction from the provided interventions/services was determined by means of an overall rating. The correlation between practiced roles and patient satisfaction with received interventions/services was determined. The questionnaire was valid with a 4-factor structure and a Cronbach alpha >0.75, reiterating the main pharmaceutical care practice domains: medication management, disease-state education, disease-state management, and care plan monitoring. Roles falling in the domains of disease state management and disease state education were significantly more practiced than roles falling in the other domains. Pharmacist practice in hypertension management in the community setting was inclined towards contemporary roles, such as disease state education and management. Patients seem to be satisfied with these roles.

Retrospective Study of Healthcare Resources Developed for Patients by Interprofessional Teams.

Wayne State University (WSU) emphasizes the importance of interdisciplinary education by having students participate in an Interprofessional Team Visit (IPTV) program. A 60-minute virtual visit is conducted to assess adults aged over 50 years within the Detroit Metropolitan Area (Metro Detroit) community. This project was designed to prepare healthcare students in evaluating the mental, physical, and social health aspects of assigned patients based on specific disciplinary assessments. Upon completion of assessments, the interdisciplinary team provided the patient with resources based on the team and the patient's agreed-upon area of concern. Twenty-eight IPTV teams, consisting of a medical and occupational therapy student and a healthcare professional student from another discipline studying at WSU, were randomly created. The IPTV resource guides created by each team were reviewed and sorted into two categories based on the health or social need of the individual patient. The data identified three main areas of interest, which included medication management, diet and exercise plans, and the use of technology to stay connected to medical professionals, friends, and family. The purpose of this report is to assess the IPTV program's findings and analyze patients' concerns based on health or social needs and the resources presented to them.

Prevalence of Post-Coronavirus Illness Conditions and Associated Risk Factors among Adults in Saudi Arabia

Objectives: Various new, recurring, or ongoing health issues that appear at least four weeks after contracting COVID-19 are known as post-coronavirus illness (COVID) conditions. Early identification of people with post-COVID conditions and development of individual medical management plans can help them feel better and improve quality of life. Therefore, the objective if this study is to determine the prevalence of post-COVID conditions among adults in Saudi Arabia and investigate risk factors associated with post-COVID conditions. Methodology: This study is a cross-sectional comparative design study. Using snowball sampling, a convenience sample of 307 Saudi adults participated in an online survey from April 2022 to August 2022 . A one-sample t-test was used to estimate the 95% confidence interval and population mean for perceived stress. The Chi-square test and odds ratio were used to assess the association and measure the effect size. Results: Post-COVID conditions was highly prevalent among adults in Saudi Arabia (74.60%). Females, young adults, and those with higher stress levels were more likely to experience post-COVID conditions contrasted to male, and middle-aged adults respectively. Perceived stress was significantly associated with all post-COVID conditions, except fever (p = 0.32) and rash (p = 0.46). Conclusions: To reduce symptoms and enhance quality of life, an individual medical management plan is required. Our results suggest that sex differences and stress levels should be considered in health promotion programs for post-COVID conditions. Attention should be paid to young adults to reduce post-COVID conditions and improve their health outcomes.

Expansion of the partnered pharmacist medication charting model on admission in the General Medicine Unit — initiation of new medications

ABSTRACTBackgroundIncreasing life expectancy has seen a continual rise in older patients who present to hospital with acute decompensation. Pharmacists are well equipped to make medication recommendations in these settings to meet patient care needs, promote harm minimisation, and improve workflow efficiency. The Partnered Pharmacist Medication Charting (PPMC) model enables pharmacists to chart regular medications for patients admitted to the General Medicine Unit (GMU) in collaboration with treating clinicians. The model was expanded to assess the safety of pharmacists additionally charting newly initiated medications.AimThe aim of this study was to assess the safety of the expanded PPMC model through the number of medication errors.MethodThis prospective observational study was conducted at a tertiary hospital. Patients admitted to the GMU and received PPMC were included. Pharmacists were able to chart any new medications as well as the patients' pre‐admission medications. The primary outcome was the number of medication errors charted on admission. Medication errors were defined as medications charted outside of the specific recommendations documented in the medication management plan written by the PPMC pharmacist and co‐signed by the admitting medical officer.ResultsA total of 8093 medications were charted by a credentialed pharmacist, with 10% (n = 816) planned newly initiated medications. Eight (0.98%) medication charting errors were identified in the PPMC model, which included five planned medications omitted. Of the 811 newly charted medications, 87 (10.7%) were amended within 24 h, with the majority being due to change in diagnosis or driven by changes in clinical status or investigative results becoming available.ConclusionThe expansion of the PPMC model of care to enable pharmacist charting of new medications was found to be safe. The adoption of the model may aid in reducing medication errors, thereby improving patient care and safety.

Coordination of Oral Anticoagulant Care at Hospital Discharge (COACHeD): protocol for a pilot randomised controlled trial

BackgroundOral anticoagulants (OACs) are commonly prescribed, have well-documented benefits for important clinical outcomes but have serious harms as well. Rates of OAC-related adverse events including thromboembolic and hemorrhagic events are especially high shortly after hospital discharge. Expert OAC management involving virtual care is a research priority given its potential to reach remote communities in a more feasible, timely, and less costly way than in-person care. Our objective is to test whether a focused, expert medication management intervention using a mix of in-person consultation and virtual care follow-up, is feasible and effective in preventing anticoagulation-related adverse events, for patients transitioning from hospital to home.Methods and analysisA randomized, parallel, multicenter design enrolling consenting adult patients or the caregivers of cognitively impaired patients about to be discharged from medical wards with a discharge prescription for an OAC. The interdisciplinary multimodal intervention is led by a clinical pharmacologist and includes a detailed discharge medication reconciliation and management plan focused on oral anticoagulants at hospital discharge; a circle of care handover and coordination with patient, hospital team and community providers; and early post-discharge follow-up virtual medication check-up visits at 24 h, 1 week, and 1 month. The control group will receive usual care plus encouragement to use the Thrombosis Canada website.The primary feasibility outcomes include recruitment rate, participant retention rates, trial resources management, and the secondary clinical outcomes include adverse anticoagulant safety events composite (AASE), coordination and continuity of care, medication-related problems, quality of life, and healthcare resource utilization. Follow-up is 3 months.DiscussionThis pilot RCT tests whether there is sufficient feasibility and merit in coordinating oral anticoagulant care early post-hospital discharge to warrant a full sized RCT.Trial registrationNCT02777047.