Medication Side Effects Research Articles

Caregiver Perspective of Benefits and Side Effects of Anti-Seizure Medications in CDKL5 Deficiency Disorder from an International Database.

CDKL5 deficiency disorder presents as a challenging condition with early-onset refractory seizures, severe developmental delays, and a range of other neurological symptoms. Our study aimed to explore the benefits and side effects of anti-seizure medications (ASMs) in managing seizures among individuals with CDKL5 deficiency disorder, drawing on data from the International CDKL5 Disorder Database. Data for this retrospective cohort study were obtained from the International CDKL5 Disorder Database, which contains responses from a baseline questionnaire administered between 2012 and 2022 and a follow-up questionnaire administered between 2018 and 2019. Families of eligible individuals were asked to provide information on ASMs that were previously and currently taken, the dose prescribed, the age at starting the medications, and the age at discontinuation for past medications. The outcome variables of interest were perceived seizure-related benefits for the current and past use of ASMs and caregiver-reported side effects. Rescue medications and infrequently used ASMs were excluded from the analysis. Descriptive statistics were used to summarise the characteristics of the study population. The study included 399 children and adults with CDKL5 deficiency disorder, descriptively analysing the perceived benefits and side effects of 23 unique ASMs based on caregiver reports. The study identified levetiracetam, topiramate, sodium valproate, vigabatrin, phenobarbital and clobazam as the most used ASMs. Notably, cannabidiol showed highly beneficial outcomes with few side effects, whereas levetiracetam and phenobarbital exhibited less favourable benefit-to-side-effect ratios. Dual therapy involving sodium valproate and levetiracetam was only used a small number (n = 5) of times but appeared effective in reducing seizure activity with relatively few side effects. Compared with monotherapy, polytherapy had a relatively higher likelihood of reported side effects than benefits. The study, leveraging a large sample size that exceeds that of previous research, emphasises the complex nature of seizure management in CDKL5 deficiency disorder. Our findings underscore the necessity of ongoing research to optimise treatment strategies, considering both the efficacy of seizure control and the potential for adverse effects. The study also points to the need for future investigations into the therapeutic potential of emerging treatments such as ganaxolone and the unresolved efficacy of cannabis products in seizure management.

What Remains to Be Discovered in Schizophrenia Therapeutics: Contributions by Advancing the Molecular Mechanisms of Drugs for Psychosis and Schizophrenia.

Schizophrenia is a frequently debilitating and complex mental disorder affecting approximately 1% of the global population, characterized by symptoms such as hallucinations, delusions, disorganized thoughts and behaviors, cognitive dysfunction, and negative symptoms. Traditional treatment has centered on postsynaptic dopamine antagonists, commonly known as antipsychotic drugs, which aim to alleviate symptoms and improve functioning and the quality of life. Despite the availability of these medications, significant challenges remain in schizophrenia therapeutics, including incomplete symptom relief, treatment resistance, and medication side effects. This opinion article explores advancements in schizophrenia treatment, emphasizing molecular mechanisms, novel drug targets, and innovative delivery methods. One promising approach is novel strategies that target neural networks and circuits rather than single neurotransmitters, acknowledging the complexity of brain region interconnections involved in schizophrenia. Another promising approach is the development of biased agonists, which selectively activate specific signaling pathways downstream of receptors, offering potential for more precise pharmacological interventions with fewer side effects. The concept of molecular polypharmacy, where a single drug targets multiple molecular pathways, is exemplified by KarXT, a novel drug combining xanomeline and trospium to address both psychosis and cognitive dysfunction. This approach represents a comprehensive strategy for schizophrenia treatment, potentially improving outcomes for patients. In conclusion, advancing the molecular understanding of schizophrenia and exploring innovative therapeutic strategies hold promise for addressing the unmet needs in schizophrenia treatment, aiming for more effective and tailored interventions. Future research should focus on these novel approaches to achieve better clinical outcomes and improve the functional level and quality of life for individuals with schizophrenia.

Selection of outcome measurement instruments for a core outcome set for trials aimed at improving appropriate polypharmacy in older people in primary care: a Delphi consensus study.

Despite developing a polypharmacy core outcome set (COS) in primary care, it is not clear how these outcomes should be measured. To select outcome measurement instruments (OMIs) for a COS targeting appropriate polypharmacy in older patients in primary care. Following the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guideline, OMIs were identified from a Cochrane review focusing on appropriate polypharmacy. The quality of OMIs was assessed using a published checklist. Subsequently, two rounds of Delphi questionnaires were conducted via the SoGoSurvey® platform, engaging stakeholders (researchers, clinicians and journal editors specialising in geriatric primary care) to achieve consensus on OMIs using a scale encompassing "agree", "disagree", or "unsure". Consensus was achieved if 70% or more participants chose "agree" and 15% or fewer chose "disagree." The quality of 20 OMIs identified from the Cochrane review was evaluated. Seven OMIs were selected based on meeting the COSMIN guideline's minimum requirements. Out of 188 potential participants, 57 (30.3%) consented to participate. Rounds 1 and 2 of Delphi exercises were completed by 50 respondents, achieving agreement on three OMIs: 'number of serious adverse drug reactions (ADRs)' (98%), 'number of deaths' (76%), and 'number of patients who fell' (70%) for measuring 'serious ADRs,' 'mortality,' and 'falls,' respectively. No agreement was reached for 'medication appropriateness,' 'medication side-effects,' 'quality of life,' and 'medication regimen complexity.' OMIs were selected for a limited number of outcomes in the polypharmacy COS. Future research should identify suitable OMIs for the remaining four outcomes.

The Brain-Heart Axis: An Umbrella Review on Impact of Psychiatric Disease on Incidence, Management, and Outlook of Cardiovascular Disease.

Psychiatric conditions, such as depression, anxiety, bipolar disorder, and schizophrenia, are increasingly recognized as significant risk factors for cardiovascular disease (CVD). This review systematically analyzes evidence from various databases to provide a comprehensive understanding of the impact of psychiatric illnesses on the incidence, management, and prognosis of CVD. Key findings suggest a bidirectional relationship between psychiatric disorders and CVD, indicating that mental health conditions can predispose individuals to CVD, while CVD can exacerbate or trigger psychiatric symptoms. The review explores the underlying mechanisms of these associations, including behavioral factors, stress responses, and medication side effects. It also examines the challenges in managing CVD patients with comorbid psychiatric conditions, emphasizing the importance for integrated care approaches. This review underscores the necessity of considering mental health as an integral component of cardiovascular care and calls for further research to develop tailored management strategies for these complex conditions, ultimately aiming to improve patient outcomes and quality of life. This comprehensive analysis provides valuable insights for future investigations and guides clinicians in optimizing care for patients with both psychiatric and cardiovascular conditions.

Pharmacogenetic educational needs and the role of pharmacogenetics in primary care: a focus group study with multiple perspectives.

Pharmacogenomics (PGx) is a well-established concept of how genes impact medication response, with many studies demonstrating reductions in medication side effects, improved efficacy and cost effectiveness. Despite these benefits, implementation of PGx in daily practice remains limited. Studies on the implementation of PGx in clinical practice have previously found that inadequate knowledge is one of the main barriers. Details regarding specifically which educational needs exist among family medicine clinicians requires further study. The aim of this study was to identify both the perceived role that pharmacogenomics (PGx) could play in primary care practice, the knowledge gaps that family medicine clinicians experience, and the skills they require to use PGx in their daily practice. To achieve this aim, the attitudes, knowledge, barriers, skills needed, and preferred educational program were explored in a family medicine clinician focus group study via a semi-structured interview and knowledge quiz. Second, multidisciplinary focus groups provided information on the level of knowledge and necessary skills to use PGx in patient care. After gathering key recorded information from both focus groups, the perceived role pharmacogenomics could possibly play in primary care, the predominant knowledge gaps, and the most appropriate educational program was determined by qualitative analysis. Four themes emerged regarding the PGx educational needs and the role of PGx in family medicine: 1) need for PGx competences, 2) insight into the roles and responsibilities of PGx services, 3) optimization of PGx workflow through artificial intelligence integrated in the electronic health record, and 4) the ethical dilemmas and psychological effects related to PGx. These themes reflect a shift in the role of PGx in family medicine with implications for education. The results obtained from this study will help improve the implementation of PGx in daily practice, and consequently, may result in increased utilization of PGx, thereby resulting in improved medication efficacy and reduced side effects.

Outcomes of a step-up approach to the treatment of neurogenic cough

IntroductionNeurogenic cough (NC) is thought to be related to sensory neuropathy in the hypopharynx and larynx. Defined as a cough persisting longer than 8 weeks refractory to standard therapy, it is a diagnosis of exclusion when other common etiologies (asthma, gastroesophageal reflux disease (GERD), medication side effects) are ruled out. It affects roughly 11 % of Americans and can negatively impact quality of life. MethodsFollowing institutional review board approval, we evaluated the medical records of adult patients seen at the University of Arizona's tertiary laryngology center from 2018 to 2023. Patients were included if their cough persisted for >8 weeks, and they either did not respond to prior proton pump inhibitor and asthma therapy or had GERD and asthma ruled out. These patients underwent a progressive escalation of therapy, which included neuromodulators with or without cough suppression therapy, superior laryngeal nerve (SLN) block, and laryngeal botulinum toxin injections. The primary outcome was patient-reported improvement in cough symptoms rated on a 1–5 scale: 1 = no response, 2 = mild improvement, 3 = moderate improvement, 4 = significant improvement, 5 = complete resolution. ResultsA total of 56 patients were included. Mean (SD) age was 64.6 (14.8) years, and 66 % were female. Overall, 42 patients (75.0 %) responded to treatment. Among responders, 7 (16.7 %) experienced mild improvement, 14 (33.3 %) experienced moderate improvement, 17 (40.5 %) experienced significant improvement, and 4 (9.5 %) experienced complete resolution of their cough.33 patients (58.9 %) were managed exclusively with neuromodulators ± cough suppression therapy; 27 responded, with an average response rating of 3.0 (SD = 1.2). 11 patients (19.6 %) failed medical therapy and underwent SLN block without subsequent botox treatment; 7 responded, with an average response rating of 2.5 (SD = 1.4). 9 patients (16.1 %) failed all previous therapies and underwent laryngeal botulinum toxin injections; 6 responded with an average response rating of 2.4 (SD = 1.3). The remaining 3 patients underwent cough suppression therapy alone, with 2 responding and an average response rating of 3.3 (SD = 1.7). ConclusionsNeurogenic cough can be effectively treated with a stepwise multimodal approach, including neuromodulators, cough suppression therapy, SLN block, and laryngeal botulinum toxin injections.

Factors affecting patient retention to hypertension treatment in a North Indian State: A mixed-method study.

Hypertension is a global health challenge, especially in low-to-middle-income countries, where awareness and control are suboptimal. Despite available treatments, poor medication adherence hampers blood pressure control, leading to adverse outcomes and increased costs. In response, the GOI has initiated national action plans to address noncommunicable diseases, including hypertension. The study aimed to analyze patient retention rates in hypertension treatment across healthcare levels and understand providers' and patients' perspectives on control factors. Using a mixed-method concurrent design in a North Indian district, retrospective data collection covered hypertensive patients registered from January 2020 to July 2020, followed for a year (August 2020-July 2021). Quantitative data included socio-demographic characteristics and patient follow-up rates. Qualitative data comprised focus group discussions (FGD) and in-depth interviews (IDI) with healthcare providers (HCPs) and patients. Findings identified challenges in patient retention and medication adherence, notably among females and at higher-level healthcare facilities, leading to substantial loss of follow-up. Only 63% of hypertensive outpatients maintained controlled blood pressure in the past year. Male patients exhibited more consistent attendance than females. Despite sufficient HCP knowledge, patient retention was better at Health and Wellness Centers (HWCs) levels, while blood pressure control was poorer at higher facilities. Barriers such as medication side effects, pill burden, and limited healthcare access hindered hypertension control, highlighting the need for improved primary care services, including extended clinic hours and diagnostic facilities. Improving hypertension control requires addressing medication adherence and healthcare access barriers. Strengthening primary care services and implementing patient-centered interventions are crucial steps.

Treatment of Type 2 Diabetes Mellitus in Advanced Chronic Kidney Disease for the Primary Care Physician.

Diabetes mellitus (DM) is a common cause of chronic kidney disease (CKD), leading to the need for renal replacement therapy (RRT). RRT includes hemodialysis (HD), peritoneal dialysis (PD), kidney transplantation (KT), and medical management. As CKD advances, the management of DM may change as medication clearance, effectiveness, and side effects can be altered due to decreasing renal clearance. Medications like metformin that were safe to use early in CKD may build up toxic levels of metabolites in advanced CKD. Other medications, like sodium-glucose co-transporter 2 inhibitors, which work by excreting glucose in the urine, may not be able to work effectively in advanced CKD due to fewer working nephrons. Insulin breakdown may take longer, and both formulation and dosing may need to be changed to avoid hypoglycemia. While DM control contributes to CKD progression, effective DM control continues to be important even after patients have been placed on RRT. Patients on RRT are frequently taken care of by a team of providers, including the primary care physician, both in and outsidethe hospital. Non-nephrologists who are involved with the care of a patient treated with RRT need to be adept at managing DM in this population. This paper aims to outline the management of type 2 DM in advanced CKD.

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.

Treatment Related Factors Associated with Non-adherence to Anti-Tuberculosis Treatment

Background: Non-adherence to anti-tuberculosis treatment may result in persistent infectiousness on the part of the patient and a higher rate of treatment failure, relapse and drug resistance and therefore, is a significant barrier to the success in tuberculosis control. Objective: To determine the treatment related factors associated with non-adherence to anti-tuberculosis treatment among tuberculosis patients. Materials and method: This case control study was carried out among purposively selected 47tuberculosis patients non-adherent to treatment (cases) and 94 tuberculosis patients adherent to treatment (controls) and were interviewed with a semi-structured questionnaire and checklist in selected DOTS centres of Dhaka city. Results: Statistical analysis shows that, factors like delay in seeking tuberculosis treatment for >6 weeks (OR=4.57; 95% CI, 1.48-14.1) and getting medicine weekly once (OR=2.8; 95% CI, 1.13-6.77) were more likely to be associated with non-adherence to treatment. Lessfrequent visit by health providers (p=0.02), no support for side effect (p=0.042) and non-observation of medication (p=0.009) were also found significant. The reasons behind missing anti-TB doses among non-adherent cases were due to feeling better (53.2%), personal reason (25.5%), feeling worse (19.1%) and forgot to take medicine (2.2%). Conclusion: Mass awareness among the tuberculosis patients is required to improve attitude towards anti-tuberculosis treatment and activities of tuberculosis control programme require further strengthening especially in targeting the patients of low economic status. Delta Med Col J. Jan 2021;9(2): 96-100

Barriers and facilitators of habit building for long-term adherence to antihypertensive therapy among people with hypertensive disorders in Los Angeles, California: a qualitative study

ObjectivesThe aim of this study was to a) explore barriers and facilitators associated with medication-taking habit formation, and b) elicit feedback on the components of an intervention designed to help...

The complications of long time treatment of insulin therapy in type-2 diabetes patients: A Review

Diabetes is a chronic metabolic disease characterized by elevated blood sugar levels. It can also mean long-term problems with the metabolism of carbohydrates caused by insulin deficiency, which leads to hyperglycemia and glycosuria. Weight gain is a common side effect of insulin therapy and other oral antidiabetic medications for diabetic patients, which can hinder their ability to meet strict glycemic targets and potentially reduce treatment success. Insulin-related weight gain is attributed to anabolic effects, appetite increases, and reduced glycosuria. Insulin therapy has been linked to increased cardiovascular risk and mortality in type 2 diabetes patients, as well as inflammation, atherosclerosis, hypertension, dyslipidemia, heart failure, and arrhythmias. Large-scale evaluations suggest that insulin therapy has a poorer short- and long-term safety profile than other anti-T2D therapies. To treat diabetes, a variety of insulin formulations are available, each acting at a distinct pace. Whether they are long-acting, intermediate-acting, or rapid-acting, there are similar adverse effects to be mindful of. Weight gain, injection site responses, and hypoglycemia (low blood glucose) are common side effects of insulin. Lipodystrophy, or improper fat distribution, and limb edema are uncommon adverse effects of insulin. When it comes to insulin introduction, titration, and follow-up treatment, doctors can manage patients with type 2 diabetes mellitus more effectively by employing simple algorithms. Primary care doctors and other medical professionals can manage patients with type 2 diabetes mellitus more easily by using streamlined insulin introduction and titration protocols.

Polymyxin B neurotoxicity as manifestation of a serious life-threatening adverse reaction: clinical case

The aim of this work is to describe a clinical case of a serious life-threatening adverse reaction in the form of neurotoxicity (convulsions, apnea requiring mechanical ventilation) to the polymyxin B drug, and also to remind that manifestations of neurotoxicity can be extremely varied and nonspecific, and do not occur after every administration, can be delayed, require vigilance and careful monitoring both from the attending physicians and from anesthesiologistsresuscitators, neurologists, ophthalmologists, etc.A 62-year-old female patient diagnosed with stage IIIB T4G3N0M0 pleomorphic soft tissue sarcoma of the right thigh, condition after combination treatment, developed infection and necrosis of the postoperative wound (recto-abdominal flap). According to the results of a microbiological study and an antibiogram, the patient received polymyxin B as part of combination antibacterial therapy. On days 4, 5, 6, 7 of polymyxin administration, the patient experienced the following symptoms in various combinations: weakness, numbness of the face, paresthesia, paresis of the limbs, partial convulsions, respiratory depression, and apnea.After establishing a connection between neurologicalsymptoms and intravenous administration of polymyxin B (the total score on the Naranjo scale was 6 points, the degree of reliability of the “adverse reaction–drug” relationship was probable) and drug withdrawal, manifestations of neurotoxicity completely disappeared and did not reoccur. The patient was discharged in satisfactory condition.In a patient with symptoms of damage to the nervous system, it is necessary to conduct multiple differential diagnostic search to exclude stroke, epilepsy, encephalitis, hereditary and acquired neurodegenerative diseases, as well as side effects of medications. At the slightest suspicion of the likelihood of an adverse reaction to polymyxin B/colistimethate sodium, the Naranjo algorithm must be used to establish a cause-and-effect relationship between the adverse reaction and the drug.

Losing, regaining, and continuing to build self-confidence – a qualitative, phenomenological study of being physically active with a type B aortic dissection

Purpose To gain a comprehensive understanding of experiences related to being physically active in participants with an uncomplicated type B aortic dissection. Materials and methods We performed a qualitative, phenomenological study. First-person accounts of adults, who at least one year ago had an uncomplicated type B aortic dissection, were collected using semi-structured interviews. The audio recordings of the interviews were transcribed verbatim and analyzed with interpretative phenomenological analysis. Results We collected, in total, 644 min interview data from 14 participants. Three patterns were interpreted: losing self-confidence, regaining self-confidence, and continuing to build self-confidence. Experiencing symptoms when pushing limits, challenges with energy management, and side effects of medication caused loss of self-confidence. Changes in identity, reaching milestones that reflect improvement, and support from others and tools helped participants regain self-confidence. To continuing to build self-confidence, participants indicated they needed success experiences and activities make life worth living. Conclusions Self-confidence in adults with an uncomplicated type B aortic dissection changes immediately after the diagnosis of the aortic dissection. Rehabilitation professionals can support adults regaining and continuing to build self-confidence, aiming for the perfect balance between blood pressure regulation, quality of life, and being physically active. Implications for rehabilitation Rehabilitation professionals should support regaining and continuing to build self-confidence related to being physically active in adults with type B aortic dissection in the early stages of recovery and beyond. Adults with an uncomplicated type B aortic dissection want rehabilitation professionals to tell them primarily what is possible (recommendations) rather than what is not allowed (rules). Rehabilitation professionals should help adults with an uncomplicated type B aortic dissection to explore, push and, ultimately, accept limits related to exercise tolerance.

Pembrolizumab-induced resolving papulosquamous eruption: An enigmatic presentation in a patient with renal cell carcinoma

Lenvatinib, a multiple tyrosine receptor kinase inhibitor, and pembrolizumab, an anti-programmed cell death protein 1 humanized antibody, both are indicated in the treatment of renal cell carcinoma (RCC). Both these agents rarely produce cutaneous adverse events. In this instance, a RCC patient who received both medications and experienced a papulosquamous eruption as an uncommon cutaneous side effect of both medications is being reported. The potential drug triggers preceded the symptom onset and the observed symptom resolved on discontinuation of pembrolizumab.

O-081 Navigating the crossroads: unraveling predictors for treatment discontinuation in couples pursuing assisted reproduction: findings from a 2-year prospective study

Abstract Study question What are the medical, individual, relationship, and clinic-related factors associated with fertility treatment discontinuation ? Summary answer Insurance status and medication use by the partner emerged as primary predictors for treatment discontinuation, while emotional burden and cost were the leading reasons cited. What is known already Despite advancements in assisted reproduction, the arduous nature of fertility treatments prompts 20 to 30% of couples to discontinue before pregnancy, even with a favorable prognosis and financial means. Whereas the World Health Organization deems treatment compliance critical for effectiveness, fundamental knowledge on fertility treatment compliance is lacking. Existing retrospective studies attribute discontinuation to the physical and psychological burdens of treatment and relationship strain. However, understanding the precise nature of psychological and relational issues influencing this decision remains limited. Additionally, previous research has overlooked patient and clinic factors related to discontinuation, hindering professionals in supporting couples through this process. Study design, size, duration A 2-year prospective study with a correlational design. The sample included 310 couples (35 same-gender/sex couples) pursuing assisted reproduction in Canada or the United States. Data were collected between December 2019 and November 2023. Participants/materials, setting, methods Couples seeking assisted reproductive services within six months of their initial visit to a fertility clinic were recruited through social media and affiliated fertility clinics. Both partners completed online questionnaires evaluating sociodemographics, medical and treatment history, psychological and relationship functioning, and their perception of patient-centered care at baseline. Follow-up assessments occurred at 6, 12, 18, and 24 months. Treatment status (ongoing, terminated due to pregnancy) and reasons for discontinuation were also recorded at each follow-up. Main results and the role of chance To identify the primary predictors of treatment discontinuation, we conducted survival analyses using sociodemographic variables (age, relationship duration, income, insurance coverage), medical and treatment history (infertility duration, medication side effects), psychological (depression, anxiety symptoms, quality of life, distress tolerance, attachment style), relationship (satisfaction, dyadic coping, commitment), and patient-centered care (communication, involvement in decisions, information accessibility) data at baseline for both partners (person to be carrying the pregnancy and their partner). Variables were initially tested separately (p < .05), and significant predictors were included in a multivariate model. In individual analyses, couples whereby the partner did not have insurance or was using anxiety/mood medication were more likely to discontinue at some point during the study. Couples in which the person to be carrying the pregnancy reported higher attachment avoidance, lower relationship commitment, or less dyadic coping were also more likely to discontinue during the study. In the comprehensive model, only the partner’s insurance and medication use predicted discontinuation. The most frequently cited reasons for discontinuation were the emotional burden of treatment (43.6%) and cost (43.7%), followed by physical discomfort (31.4%), loss of hope regarding treatment (33.3%), reasons related to services in clinics (28.6%), and personal circumstances impeding treatment (27.5%). Limitations, reasons for caution Given the correlational study design, causation cannot be inferred between identified predictors and treatment discontinuation. The 2-year study duration also limits capturing later discontinuations. Predictors were assessed at baseline only, potentially differing across treatment stages. Finally, 2SLGBTQ+ couples experiencing social infertility are underrepresented in the sample. Wider implications of the findings These findings underscore the importance of addressing insurance accessibility and psychological factors in fertility treatment support. Elevated emotional burden and cost as prominent discontinuation reasons highlight the need for comprehensive, affordable care and emotional support in fertility clinics to improve overall patient experience and outcomes. Trial registration number n/a

Dyslipidemia among psychiatric patients with depression – common possible reasons and treatment implications – review

Dyslipidemia is a medical term used to describe an abnormal level of lipids (fats) in the blood. This can include elevated levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, high density protein lipoprotein (HDL) cholesterol and serum triglicerides. Depression, also known as depressive disorder, is a common mental illness. It is characterized by a persistent feeling of sadness, loss of pleasure, or lack of interest in activities that are present of at least two weeks and significantly impair patient everyday functioning. Dyslipidemia and depression can co-occur due to a complex interplay of shared risk factors, such as inflammation, metabolic syndrome, medication side effects, and lifestyle changes, suggesting a bidirectional relationship where each condition might contribute to the development or exacerbation of the other. Given these considerations, a comprehensive approach to managing dyslipidemia in psychiatric patients with depression is essential. This should include regular monitoring of lipid profiles and monitoring of anticholesterol and antidepressant drugs. Interestingly, simple lifestyle changes, such as a healthy diet and exercise, have an impact on the treatment of depression and dyslipidemia.

Implementing the information system for older adult patients post-discharge self-management: a qualitative study.

Discharging older adult patients from the hospital poses risks due to their vulnerable conditions, complex instructions and limited health literacy. Insufficient information about medication side effects adds to patient concerns. To address this, a post-discharge information summary system was developed. While it has shown positive impacts, concerns exist regarding implementation fidelity. This study employed a theory-driven approach to understand health providers' perspectives on effective implementation. Individual semi-structured interviews were conducted via telephone with nurses, doctors and pharmacists from local public hospitals. All interviews were audio-recorded and transcribed verbatim. Theoretical Domains Framework (TDF) was applied for direct content analysis. Belief statements were generated by thematic synthesis under each of the TDF domains. A total of 98 participants were interviewed. Out of the 49 belief statements covering eight TDF domains, 19 were determined to be highly relevant to the implementation of the post-discharge information summary system. These TDF domains include knowledge, skills, social/professional role and identity, beliefs about consequences, intentions, memory, attention and decision processes, environmental context and resources and social influences. Our study contributes to the understanding of determinants in implementing discharge interventions for older adult patients' self-care. Our findings can inform tailored strategies for frontline staff, including aligning programme rationale with stakeholders, promoting staff engagement through co-creation, reinforcing positive programme outcomes and creating default settings. Future research should employ rigorous quantitative designs to examine the actual impact and relationships among these determinants.

‘The health care system is more like a business’—medical overuse from the patients’ perspective in Germany: a qualitative study

ObjectivesMedical overuse exposes patients to unnecessary risks of harm. It is an open question whether and how patients perceive the concept of medical overuse, its causes and negative consequences.DesignA qualitative...

Efficacy of Pharmacological Treatments in Managing Generalized Anxiety Disorder among Adults in Saudi Arabia: A Cross-sectional Analysis

Abstract Introduction: Generalized anxiety disorder (GAD) is a significant mental health concern characterized by excessive and uncontrollable worry about everyday activities. Despite its prevalence, there is a scarcity of research on pharmacological management strategies for GAD, particularly within the Saudi Arabian context. This study aims to address this gap by identifying and evaluating the most commonly used pharmacological strategies among adults in Saudi Arabia. It will assess the effectiveness of these strategies, examine factors influencing the preference of these strategies, and explore the prevalence and impact of adverse effects associated with them. Methods: This cross-sectional study employed stratified random sampling to select a representative sample of adults aged 18 years and above from various regions of Saudi Arabia. Participants provided data through self-administered questionnaires, which included information on sociodemographic characteristics, GAD symptoms, pharmacological strategies utilized, their effectiveness, and any adverse effects. The study’s analytical approach encompassed statistical methods such as correlation, regression, and Chi-square tests, aiming to uncover relationships and patterns among the collected data, particularly focusing on treatment efficacy and the occurrence of adverse effects. Results: We found a demographic skewing among Saudi patients with GAD, particularly toward young adults aged 18–24 and women. The majority of these patients were diagnosed with GAD and had been experiencing symptoms for less than six months. In addition, there was a notable willingness among them to seek professional help. The most commonly used pharmacological strategy was classified as “Others,” with a high satisfaction rate reported by users. Adverse effects were infrequent, affecting only a minority of patients frequently. Selective serotonin reuptake inhibitors demonstrated the highest mean improvement in GAD symptoms, indicating their effectiveness. Our study also emphasized the importance of considering medication side effects, especially for individuals with a greater tendency to adverse events. Conclusion: This research emphasizes the importance of personalized treatment plans, medication efficacy, and side effect profiles for managing GAD in Saudi Arabia. It also underscores the need for evidence-based treatment guidelines and suggests areas for future research to optimize GAD treatment strategies based on individual patient needs and therapy responses.