Prescription Process Research Articles

Optimizing Hospital Electronic Prescribing Systems: A Systematic Scoping Review.

ObjectiveConsiderable international investment in hospital electronic prescribing (ePrescribing) systems has been made, but despite this, it is proving difficult for most organizations to realize safety, quality, and efficiency gains in prescribing. The objective of this work was to develop policy-relevant insights into the optimization of hospital ePrescribing systems to maximize the benefits and minimize the risks of these expensive digital health infrastructures.MethodsWe undertook a systematic scoping review of the literature by searching MEDLINE, Embase, and CINAHL databases. We searched for primary studies reporting on ePrescribing optimization strategies and independently screened and abstracted data until saturation was achieved. Findings were theoretically and thematically synthesized taking a medicine life-cycle perspective, incorporating consultative phases with domain experts.ResultsWe identified 23,609 potentially eligible studies from which 1367 satisfied our inclusion criteria. Thematic synthesis was conducted on a data set of 76 studies, of which 48 were based in the United States. Key approaches to optimization included the following: stakeholder engagement, system or process redesign, technological innovations, and education and training packages. Single-component interventions (n = 26) described technological optimization strategies focusing on a single, specific step in the prescribing process. Multicomponent interventions (n = 50) used a combination of optimization strategies, typically targeting multiple steps in the medicines management process.DiscussionWe identified numerous optimization strategies for enhancing the performance of ePrescribing systems. Key considerations for ePrescribing optimization include meaningful stakeholder engagement to reconceptualize the service delivery model and implementing technological innovations with supporting training packages to simultaneously impact on different facets of the medicines management process.

Improving before-noon discharges in the acute medical ward

Background: Mismatch in admission and discharge rates with poor coordination of bed availability to prepare for peak admission time do not favor patient flow in any healthcare situation. In order to meet the admissions demand from the emergency department, early discharge is advocated. Aim: The purpose of this study was to increase the 11:30 discharge rate in the acute medical ward to 20% within 5 months in order to facilitate patient transfers from the emergency department. Method and intervention: A nurse-led multidisciplinary team discussion at 10:00 was formed empowering nurses and aims to prioritize early discharges or transfer patients who require a longer stay in the hospital. The indication of expected discharge date was determined by team doctors on either day 1 or 2 of admission, to facilitate and prioritize allied health intervention or even prescription processing. Physical transfer to the discharge lounge was to occur earlier, awaiting preparation of prescription and documentation. Dedicated nursing staff who manage the discharge lounge processes, were to ensure the transfers and care arrangements to be smooth and coordinated with enhanced communication to next of kin. Results: The overall median rate for discharges before 11:30 in the acute medical ward was at 17%, compared to baseline median discharge rate of 12% ( p=0.05) and evening discharges that remained. With the implementation of a framework for multidisciplinary team discussion, the mean time spent on multidisciplinary team reduced to 40 min from the pre-intervention stage, ranging approximately 57–68 min. Conclusion: The discharge process is complex and requires multidisciplinary team collaboration and coordination. This project also created an opportunity for more relevant project targeting evening discharges that addresses another emergency department peak admission time.

Errores de medicación en pediatría

Medication errors (ME) are preventable incidents of inappropriate use of medications by health per sonnel or by the patient. These events can occur at any stage of drug use generating significant costs to the health system and, in some cases, these can even lead to death. The pediatric population is con sidered susceptible to ME with a prevalence 3 times higher than adult patients. To identify the prevalence of medication errors in hospitalized pediatric patients, as well as their classification according to the stage of use of the medication when they occurred. A literature review of ME in pediatrics was carried out through a Pubmed / Medline search using Mesh terms ("Medication Errors" and "Pediatrics") in the last 10 years. Three investigators reviewed independently the identi fied articles considering the STROBE checklist for observational studies. 192 bibliographic references were identified, 22 of them were eligible for review and data collection. Studies reported an error rate between 1% and 58% of the evaluated medication indications, with errors reported in different processes of drug use. 9 articles (41%) described errors related only to prescription, mainly associated with incorrect dosage, 6 (27%) errors related to prescription, administration, and other processes, 3 (14%) related to prescription and administration, 2 (9%) related only to administra tion, 1 (4%) article reported errors related to conciliation, and 1 (4%) described errors related to preparation and administration. The studies reported different medication errors in the pediatric population. Most of them reported ME related to prescription followed by ME in the administration. Knowing the proportion of ME allows focusing interventions aimed at reducing their prevalence.

A conceptual design of modified Human Factor Analysis and Classification System mobile application

This article aims to provide a conceptual design of the medication error identification based on a mobile application using the modified HFACS approach. The conceptual design in this study discusses the user and functional requirements based on the organizational structure and business process of medication prescription. This study used DFD that aims to describe the relationship among the user. Interface and prototype of the application is developed based on a focused group discussion of ergonomics expert. The user involved in the prescription process are the doctors, hospital workers from the pharmaceutical department, and hospital workers from the Hospital Patient Health department. The role of HFACS investigation is played by the patient-health department. The developed interface of HFACS focuses on the evaluation and documentation of medication error cases. This present study is the first study focus on the development of HFACS mobile application in evaluating and documenting medication error.

Understanding the implementation and medium-longer term sustainability of the primary care prescribing safety intervention, PINCER: preliminary results from a longitudinal process evaluation

Abstract Introduction Medication errors are an important cause of morbidity and mortality across primary care in England. In the National Health Service, approximately 71% of 237 million medication errors made annually are attributable to primary care(1). The complex pharmacist-led IT-based intervention to reduce clinically important medication errors (PINCER) intervention has been shown to significantly reduce medication errors when tested in a cluster randomised controlled trial and when implemented on a larger scale across one geographical region of England. However, with a national rollout of PINCER now underway across England, there remains a limited understanding of whether and how wider implementation, impact and medium-longer term sustainability across diverse regions is achieved, and what factors may influence these processes. Aim This study aimed to explore the contextual factors that influenced the nature and extent of translation, implementation and sustained use of PINCER in diverse settings over time. Methods Intervention developers and personnel involved in the PINCER rollout and staff members from Academic Health Science Networks (AHSNs), Clinical Commissioning Groups (CCGs) and general practices from four regions of England, UK, were purposively recruited via research team connections and Clinical Research Networks. Interviews aimed to capture short-term (≤6 months), medium-term (6 – 18 months) and long-term (≥ 18 months) use of PINCER. Interview guides were informed by Normalisation Process Theory (NPT). Semi-structured, face-to-face or telephone interviews were conducted and digitally recorded. A preliminary thematic analysis was performed on the data collected. Results Forty-eight participants from 30 establishments, including two intervention developers, three involved in the PINCER rollout and five AHSN, seven CCG and thirty-one general practice employees were interviewed between June 2018 – June 2020. Their engagement with PINCER had either been in the medium (n=13) or long-term (n=17), (range 8 months - 5 years plus). Emerging themes identified in the preliminary analysis were: development and spread which incorporated intervention and training improvements as well as uptake, perceptions of PINCER which included awareness of PINCER as well as opinions on it and factors influencing the use of PINCER and sustainability which were mainly contextual but also related to PINCER functionalities. Within the development and spread theme, and relating to perceptions of PINCER theme, clear communication and ensuring there was an understanding of what PINCER entailed was considered important in initiating interest and uptake. Overall, PINCER was perceived positively. Key challenges to the implementation of PINCER identified were initial IT issues and workload. Policies advocating the use of PINCER, evidencing impact in reductions in the number of patients identified as being ‘at risk’ of hazardous prescribing and being able to benchmark results against other CCGs and practices helped facilitate the implementation and sustainability. Some changes made to prescribing and monitoring processes as a result of the implementation and use of PINCER, appeared to have become embedded into routine practice giving an indication of sustainable use. Conclusion Further interviews will establish if and how PINCER has been more widely adopted and normalised within primary care, in order to generate important learning to support its optimal and sustainable impact.

Periods of altered risk for non-fatal drug overdose: a self-controlled case series

Being recently released from prison or discharged from hospital, or being dispensed opioids, benzodiazepines, or antipsychotics have been associated with an increased risk of fatal drug overdose. This study aimed to examine the association between these periods and non-fatal drug overdose using a within-person design. In this self-controlled case series, we used data from the provincial health insurance client roster to identify a 20% random sample of residents (aged ≥10 years) in British Columbia, Canada between Jan 1, 2015, and Dec 31, 2017 (n=921 346). Individuals aged younger than 10 years as of Jan 1, 2015, or who did not have their sex recorded in the client roster were excluded. We used linked provincial health and correctional records to identify a cohort of individuals who had a non-fatal overdose resulting in medical care during this time period, and key exposures, including periods of incarceration, admission to hospital, emergency department care, and supply of medications for opioid use disorder (MOUD), opioids for pain (unrelated to MOUD), benzodiazepines, and antipsychotics. Using a self-controlled case series, we examined the association between the time periods during and after each of these exposures and the incidence of non-fatal overdose with case-only, conditional Poisson regression analysis. Sensitivity analyses included recurrent overdoses and pre-exposure risk periods. We identified 4149 individuals who had a non-fatal overdose in 2015-17. Compared with unexposed periods (ie, all follow-up time that was not part of a designated risk period for each exposure), the incidence of non-fatal overdose was higher on the day of admission to prison (adjusted incidence rate ratio [aIRR] 2·76 [95% CI 1·51-5·04]), at 1-2 weeks (2·92 [2·37-3·61]), and 3-4 weeks (1·34 [1·01-1·78]) after release from prison, 1-2 weeks after discharge from hospital (1·35 [1·11-1·63]), when being dispensed opioids for pain (after ≥4 weeks) or benzodiazepines (entire use period), and from 3 weeks after discontinuing antipsychotics. The incidence of non-fatal overdose was reduced during use of MOUD (aIRRs ranging from 0·33 [0·26-0·42] to 0·41 [0·25-0·67]) and when in prison (0·12 [0·08-0·19]). Expanding access to and increasing support for stable and long-term medication for the management of opioid use disorder, improving continuity of care when transitioning between service systems, and ensuring safe prescribing and medication monitoring processes for medications that reduce respiratory function (eg, benzodiazepines) could decrease the incidence of non-fatal overdose. Murdoch Children's Research Institute and National Health and Medical Research Council.

Assessing and addressing barriers towards MDI use in acute asthma exacerbations at a tertiary pediatric ED in the United Arab Emirates.

Asthma is one of the most common causes of emergency department (ED) visits in children. Therapy delivered through a meter dose inhaler with spacer (MDI + S) is equally as effective as nebulization in mild and moderate asthma exacerbations but was not routinely prescribed in the ED at the largest tertiary center for pediatrics in the United Arab Emirates (UAE). Phase 1 of this cohort study involved a validated survey to evaluate physicians’ knowledge, attitudes and perceptions towards MDI therapy. While 62% of physicians reported that MDI + S was equally effective as nebulizers and 82% believed that they had sufficient knowledge with regard to its use, only 28% prescribed it. Perceived barriers to change of practice included: Lack of clinical practice guidelines (CPG), poor knowledge amongst nurses and physicians, caregivers’ reluctance and a difficult prescription process. Phase 2 consisted of administering the same survey after completing interventions to address the aforementioned barriers. Comparisons were made between the subgroups within phase 1 and statistically significant differences were noted with a p value < .05. The number of physicians who prescribed MDI + S increased from 28% to 41% (p value = .046). Moreover, physicians who believed that convincing parents to use MDI + S therapy would be easy, increased from 35% to 66% (p value < .0001). In conclusion, more physicians reported prescribing MDI + S in Phase 2 while concerns about barriers that exist to change in practice remained similar in both phases showing that consistent and prolonged advocacy is required to achieve long-term compliance.

Medication‐related problems in chronic inflammatory conditions: A pharmacy claims and electronic health record analysis

AbstractBackgroundSpecialty medications have transformed management of chronic inflammatory conditions. There is a critical need to elucidate underlying barriers and medication‐related problems (MRPs) that might contribute to specialty medication non‐adherence in order to minimize disease progression, treatment failure, and increased healthcare utilization.ObjectiveTo characterize MRPs for patients taking specialty medications for chronic inflammatory conditions and identify factors associated with experiencing MRPs.MethodsRetrospective cohort study of patients prescribed specialty medications for chronic inflammatory conditions at a single, regional, tertiary medical center, who filled their prescriptions at Walgreens pharmacy between 1/1/2014 and 12/31/2016. Electronic health records were manually reviewed to find documented medication problems. MRPs were then analyzed to identify common themes. Differences in baseline characteristics for patients with or without documented MRPs were compared using Fisher's exact test for categorical variables and Mann Whitney U test for continuous variables. Student's t test was used to determine associations between 12‐month proportion of days covered (PDC) and the presence of any MRP.ResultsOf 272 patients who were prescribed specialty medications for chronic inflammatory conditions, 98 patients (36%) experienced a total of 131 documented MRPs. Four major themes associated with these problems emerged: prescription processing issues (31%), insurance problems (24%), medication use problems (22%), and side effects (18%). Patients were less likely to have a documented MRP if they were African American (P = .032) and patients with MRPs had a greater proportion of missed clinic visits. Mean 12‐month PDC (n = 167) was 0.61 and was not significantly associated with having a documented MRP (P = .7).ConclusionUse of specialty medications for patients with chronic inflammatory conditions continues to increase. Gaining a greater understanding of the MRPs that affect specialty medication use for chronic inflammatory conditions can help identify practice innovations and policies to improve patient care.

Perspectives of Multidisciplinary Professional Teams during Assessment Processes for ATD Selection in the Japanese Public Provision System.

Selection of assistive technology devices (ATDs), which are imperative for persons with disabilities to improve their quality of life, requires collaboration of users and multidisciplinary professionals. However, it is still unknown how to design and implement an adequate collaborative work flow and a professional team. Under Japanese governmental ATD provision system, based on the application by clients, ATDs are mainly selected through collaborative processes with the clients and health professionals in public organizations, rehabilitation counseling centers (RCCs). By employing qualitative study methods in this study, we investigated the ATD selection process in which health professionals in RCCs collaboratively assess clients with physical disabilities so as to support them in selecting the adequate ATDs. To identify the perspectives required for ATD selection completely, the assessment processes were recorded and analyzed with a pseudo setting in two RCCs. Content analysis of the conversations between the client and professionals revealed the characteristics of the information exchanged in the assessment processes. A total of 760 assessment items were identified, thus indicating a broad array of interest. Despite the richness of information collected for the assessment, half of the assessment items did not have corresponding items in the documents that were employed during the prescription process. Thematic analysis of the interviews that followed revealed the common values and collaborative processes in ATD selection, which were shared and elaborated among the staff in daily social interactions. To facilitate implementation of ATD provision in various areas with few resources, it may be effective to convert this tacit-to-tacit knowledge sharing into a more explicit sharing by promoting analyses of good practices.

Treatment Adherence in Chronic Conditions during Ageing: Uses, Functionalities, and Cultural Adaptation of the Assistant on Care and Health Offline (ACHO) in Rural Areas.

The increasingly common scenario of an ageing population is related to a rise in the prevalence of problems associated with chronic conditions and comorbidities. Polypharmacy is frequent among this population, and it is a situation that can create medication management and adherence issues. This article introduces the features and functionalities of a voice assistant (Assistant on Health and Care Offline, ACHO) that aims to facilitate treatment adherence among elderly adults. Specifically adapted for its use in rural contexts, it does not require an Internet connection. Its development consisted of two stages: a first stage of problem diagnosis, in which the classic tools of ethnographic fieldwork were used, and a second stage of design implementing methodologies developed by Ambient Assisted Living (AAL) programmes. The main design characteristic of this new digital care system is that it is adapted to the needs of its end-users. It includes features such as voice customisation and the personal identification of medication, it can be connected to other digital devices, and information is introduced and supervised by healthcare professionals. These custom features introduce a safer medication administration procedure, improve supervision strategies, and increase patients’ trust in the prescription process.

Personalized Gait Treatment Using Passive Controllable Ankle Foot Orthosis

Ankle Foot Orthosis (AFO) is usually prescribed for gait treatment. Low cost, easy to fabricate, safe, long term usage, and personalized AFO is demanded to facilitate and accelerate the prescription process, which is iterative, individualized, and collaborative. Passive Controllable AFO (PICAFO) was developed to fulfil the demand, consisting of several research works, such as the gait detection method, smart actuator design, and controller development. Two gait detection methods had been considered. Firstly, the system utilized the Electromyography (EMG) biosignal to detect the stance and swing phase. Secondly, hybrid Magnetorheological Elastomer (MRE) is used to detect four gait phases based on foot contact. The smart actuator, a small scale Magnetorheological (MR) brake, had been constructed, which generated 2.1 Nm maximum damping stiffness to partially support the ankle stiffness. The controller is essential because controlling the damping stiffness accordingly to the current gait ensures positive assistance. The latest version of the PICAFO controller utilized ankle velocity reference to control the MR brake stiffness, which can be estimated based on the user’s walking speed and body mass index. The presented research works show that achieving personalized gait treatment using the PICAFO system is possible.

Near miss na atenção primária í saúde e a segurança do paciente

Objetivo: Identificar as evidências sobre os incidentes near miss em serviços de atenção primária í saúde. Método: Revisão integrativa de literatura a partir de artigos primários publicados em sete bases de dados. Utilizou-se os descritores "near miss", "atenção primária í saúde" e "gestão da segurança" sem limitações quanto ao ano de publicação e idiomas. Resultados: Os tipos de incidentes near miss notificados com maior frequência estavam relacionados a erros de medicação, com variação entre 6,2% e 96%, e o processo de prescrição foi o mais recorrente. Os profissionais de saúde foram os responsáveis por interceptar entre 66% a 83% dos incidentes. Conclusão: A notificação de incidentes near miss deve ser incentivada e incorporada nas práticas gerenciais. Conhecer precocemente os erros e seu potencial de dano possibilita ações de melhorias para segurança do paciente.

Prescriber behaviours that could be targeted for change: An analysis of behaviours demonstrated during prescription writing in children.

The prescribing process for children with cancer is complex, and errors can occur at any step. As a result, many interventions have been used to reduce errors. However, few of them have been designed based on an understanding of the prescriber behaviour that can lead to errors. In order to design effective behaviour change interventions, it is important first to understand the prescribing process and identify prescriber behaviours that could be targeted for change. To describe the prescribing process in a paediatric oncology ward and to identify prescriber behaviours during prescription writing that could be targeted to reduce errors. This study employed two sequential phases. First, the prescribing process was observed and then described using the hierarchical task analysis (HTA) method. Second, prescriber tasks identified from the HTA were analysed using the behaviour change wheel (BCW) approach to identify promising behaviours for change. These identified behaviours were prioritised based on information collected from four focus groups with prescribers and chart review of errors made in the ward. The prescribing process was complex and involved multiple tasks performed in varying orders. Applying the BCW identified thirty-two candidate behaviours for potentially reducing prescribing errors. However, after prioritization, only two emerged as promising candidate behaviours for intervention: writing drug indications at the time of prescribing and using a pre-written order when ordering medications through electronic prescribing. This research suggests that two behaviours could be promising in reducing errors. Having identified these behaviours, future work could explore what needs to change with respect to individuals and their work environments to achieve the desired change in these identified behaviours.

Commentary: Microbial Resistance Movements: An Overview of Global Public Health Threats Posed by Antimicrobial Resistance, and How Best to Counter.

“Superbugs” are the antimicrobial-resistant microorganisms. Bacteria, viruses, fungi, and parasites acquire the ability to evade the antimicrobial drug effects, not only to survive but also, in some cases, become more virulent. As such, the existing antimicrobial drugs are no longer effective and useful in treating the infections (used to be treatable). Superbug-induced infections are the major worldwide health concern with higher human mortality and an increased financial burden on society. The underlying mechanism of the evolvement of drug-sensitive to drug-resistant microorganisms is an extremely complex phenomenon. It is partly related to microorganism's unique ability to modify their genetic structures and biochemical functionality to survive and keep growing even in the presence of antimicrobial drugs. Since there are multiple factors involved in developing antimicrobial drug resistance, it cannot be reversed by adopting a single prevention strategy. Of importance, certain bacterium may not require antimicrobial drug exposure to develop resistance, as surrounding environmental exposure can facilitate the resistance. Consistent misuse and overuse of antimicrobial drugs by healthcare professionals and consumers with its extensive use in food and meat production have put human health at risk. Lack of resources for research and low interest in developing the newer generation of antimicrobial drugs are also contributing to the evolution of superbugs. Without global involvement, partnership and collaboration, superbug-induced morbidity and mortality will be unmanageable in the future. To address this impending global health crisis, in May 2015, the World Health Organization (WHO) assembly adopted a global action plan to combat the antimicrobial resistance, that include (1) to increase the awareness of antimicrobial resistance, (2) to advance research and surveillance, (3) to cut down the rate of infections through preventive measures, (4) to ensure the optimal use of antimicrobial drugs, and (5) to develop sustainable investment, taking into account the needs of the countries, to develop novel interventions. Unfortunately, implementing such WHO measures have both financial and logistic hurdles, and the rates of superbug-induced infections are alarmingly increasing. A recently published article in “Frontiers in Public Health” has highlighted the importance of microbial resistance movements to reduce the burden of superbug-induced infections (1). The authors have elaborated on the genesis of antimicrobial drugs and listed the challenges of producing the newer generation of drugs to combat existing drug-resistant pathogens (1). Although the authors briefly touched on the irrational prescription of antimicrobial drugs in the both developed and developing countries, the review article did not discuss in depth the regulatory enforcement procedures to minimize the antimicrobial resistance (1). The opportunities and challenges of global standardization of the antimicrobial prescription processes were not explained in detail in the publication (1). Another critical area that was not emphasized enough in the article was the use of the antimicrobial drugs on animals and its potential consequences in developing antimicrobial resistance. This commentary will briefly elaborate on the cross-species transmission of resistant pathogens from animal to human. Appreciating that one single review article cannot cover all the aspects of antimicrobial resistance, the authors have fittingly highlighted the scientific and economic challenges that are hindering the novel antimicrobial drug development (1). The publication has justifiably concluded that antimicrobial resistance is a multifaced issue driven by numerous interrelated factors, and therefore, the use of any single intervention would have limited success (1). Recent publications have also emphasized why implementing an antimicrobial stewardship program is necessary to prepare the future medical professionals to enhance their awareness and knowledge of antimicrobial resistance to reduce the disease burden related to superbug-mediated infections (Figure 1) (2, 3). Open in a separate window Figure 1 Schematic diagram showing the main steps needed to be implemented to minimize the antimicrobial drug resistance (2).

Using self-determination theory to understand the social prescribing process: a qualitative study.

BackgroundSocial prescribing (SP) assists patients to engage in social activities and connect to community supports as part of a holistic approach to primary care. Rx: Community was a SP project, which was implemented within 11 community health centres (CHCs) situated across Ontario, Canada.AimTo explore how SP as a process facilitates positive outcomes for patients.Design & settingQualitative methods were used. Eighteen focus groups were conducted at CHCs or by video-conferencing, and involved 88 patients. In addition, eight in-depth telephone interviews were undertaken.MethodInterviews and focus groups were transcribed verbatim, and analysed thematically using a theoretical framework based on self-determination theory (SDT).ResultsParticipants who had received social prescriptions described SP as an empathetic process that respects their needs and interests. SP facilitated the patient’s voice in their care, helped patients to develop skills in addressing needs important to them, and fostered trusting relationships with staff and other participants. Patients reported their social support networks were expanded, and they had improved mental health and ability in self-management of chronic conditions. Patients who became involved in SP as voluntary 'health champions' reported this was a positive experience and they gained a sense of purpose by giving back to their communities in ways that felt meaningful for them.ConclusionSP produced positive outcomes for patients, and it fits well within the community health centre model of primary care. Future research should examine the impact on health outcomes and examine the return on investment of developing and implementing SP programmes.

Concordance and non-compliance: a psychological perspective

Promoting concordance is a key element of all non-medical prescribing practise. However, more than half of medications prescribed are not taken properly or not taken at all. The reasons for a patient's non-compliance with prescribed medication is complex but the factors that promote compliance are becoming more clearly understood. This article considers what is now understood about the psychological impact prescribing medication has on patients and emphasising the need for prescribers to think about the role they adopt when prescribing. It recommends key communication skills that support the patient's psychological adjustment to change and acknowledges that the prescribing process often forms part of a larger process in which patients are adapting to significant life events. Concordance therefore hinges on skills like empathy and ensuring a prescribers approach to prescribing is truly person centred.

Chinese Herbal Prescription Fu-Zheng-Qu-Xie Prevents Recurrence and Metastasis of Postoperative Early-Stage Lung Adenocarcinoma: A Prospective Cohort Study Followed with Potential Mechanism Exploration.

Chinese herbal Fu-Zheng-Qu-Xie (FZQX) prescription has been found to improve the immune function and survival of patients with early-stage lung cancer. However, the therapeutic efficacy needs to be evaluated objectively, and the precise mechanism remains unclear. In the present study, a double-center, prospective cohort study was carried out to assess the clinical efficacy of the FZQX prescription in preventing the recurrence and metastasis of postoperative early-stage lung adenocarcinoma. Our results indicated that the FZQX prescription could significantly reduce the 3-year postoperative recurrence rate and improve the life quality. Moreover, the peripheral blood indices showed that the positive immune index (CD4+T/CD8+T) increased and the negative immune indices (CD8+T, Myeloid-derived suppressor cells (MDSCs), Treg) decreased after treatment with the FZQX prescription. Since the positive regulatory effect of the FZQX prescription on immune function, a series of experiments were conducted to verify the tumor-suppressive effect and elucidate the underlying mechanisms. Through the MDSC clearance xenograft model, we confirmed that the FZQX prescription could effectively suppress tumor growth with lesser side effects in vivo, and MDSCs may be involved in the biological process of the FZQX prescription's intervention in lung cancer progression. By establishing the coculture system of MDSCs/LLC to simulate the immune microenvironment of lung cancer, the tumor suppression effect of the FZQX prescription was further validated by in vitro experiments. Besides, it was confirmed that the FZQX prescription could regulate MDSCs to remodel the immunosuppressive tumor microenvironment, thus exerting its preventive effect on relapse of lung cancer. Finally, the pathway activator and inhibitor were further used to explore the potential molecular mechanism. Results demonstrated that the IL-1β/NF-κB signaling pathway was one of the critical signaling pathways of FZQX prescription regulating MDSCs to prevent the recurrence and metastasis of lung adenocarcinoma.

Docetaxel loaded mPEG-PLA nanoparticles for sarcoma therapy: preparation, characterization, pharmacokinetics, and anti-tumor efficacy

Sarcoma represents one of the most common malignant tumors with poor treatment outcomes and prognosis. Docetaxel (DTX) is acknowledged as one of the most important chemotherapy agents. The aim of this study was to improve the efficacy of docetaxel by incorporation into the mPEG-PLA nanoparticle (DTX NP) for the treatment of sarcoma. The DTX NP was prepared by emulsion solvent diffusion method and the prescription and preparation process were optimized through a single factor experiment. The optimized DTX NP was characterized by drug loading, encapsulation efficiency, drug release, etc. Then, the pharmacokinetics was conducted on rats and tumor-bearing ICR mice. Finally, the anti-tumor efficacy of DTX NP with different dosages was evaluated on tumor-bearing ICR mice. The optimized DTX NP was characterized by around 100 nm sphere nanoparticles, sustained in vitro drug release with no obvious burst drug release. Compared with DTX injection, the AUC of DTX NP increased by 94.7- and 35.1-fold on the rats and tumor-bearing ICR mice models, respectively. Moreover, the intra-tumoral drug concentration increased by 5.40-fold. The tumor inhibition rate of DTX NP reached 94.66%, which was 1.24 times that of DTX injection (76.11%) at the same dosage, and the bodyweight increase rate was also higher than the DTX injection. The study provided a DTX NP, which could significantly improve the bioavailability and therapeutic efficacy of DTX as well as reduced its toxicity. It possessed a certain prospect of application for sarcoma treatment.

Opportunities for improving how and when Canadians are informed about new prescription medications

The Canadian prescription process requires a person to go through several steps. Prescription medications have associated risks and benefits and it is important for people to be aware of these before and while they are taking medications. One of the approaches to informing people about new prescription medications is that they are provided Consumer Medication Information (CMI). CMI is given to Canadians at the pharmacy when they pick up prescriptions, they will be taking for the first time. This study used semi-structured interviews to examine the lived experiences of a sample of Canadians (N = 36) to identify opportunities for improvement in how and when they are informed about new prescription medications. The findings were synthesized into a journey map. Generally, participants wanted to receive CMI digitally and earlier in the prescription process. Adopting these changes could have several benefits which include loss prevention and increased accessibility to CMI as well as more participatory decision making and opportunities to ask questions. Future research is warranted to explore similar topics with a larger sample and determine what method (e.g., email, website, mobile application) would be most suitable.

Identifying the essential nodes in network pharmacology based on multilayer network combined with random walk algorithm

Compared with the general complex network, the multilayer network is more suitable for the description of reality. It can be used as a tool of network pharmacology to analyze the mechanism of drug action from an overall perspective. Combined with random walk algorithm, it measures the importance of nodes from the entire network rather than a single layer. Here a four-layer network was constructed based on the data about the action process of prescriptions, consisting of ingredients, target proteins, metabolic pathways and diseases. The random walk algorithm was used to calculate the betweenness centrality of the protein layer nodes to get the rank of their importance. According to above method, we screened out the top 10% proteins that play a key role in treatment. Prescriptions Xiaochaihu Decoction was taken as example to prove our method. The selected proteins were measured with the ones that have been validated to be associated with the treated diseases. The results showed that its accuracy was no less than the topology-based method of single-layer network. The applicability of our method was proved by another prescription Yupingfeng Decoction. Our study demonstrated that multilayer network combined with random walk algorithm was an effective method for pre-screening vital target proteins related to prescriptions.