Care Strategies Research Articles

Sentiment analysis in medication adherence: using ruled-based and artificial intelligence-driven algorithms to understand patient medication experiences.

Studies are exploring ways to improve medication adherence, with sentiment analysis (SA) being an underutilized innovation in pharmacy. This technique uses artificial intelligence (AI) and natural language processing to assess text for underlying feelings and emotions. This study aimed to evaluate the use of two SA models, Valence Aware Dictionary for Sentiment Reasoning (VADER) and Emotion English DistilRoBERTa-base (DistilRoBERTa), for the identification of patients' sentiments and emotions towards their pharmacotherapy. A dataset containing 320,095 anonymized patients' reports of experiences with their medication was used. VADER assessed sentiment polarity on a scale from - 1 (negative) to + 1 (positive). DistilRoBERTa classified emotions into seven categories: anger, disgust, fear, joy, neutral, sadness, and surprise. Performance metrics for the models were obtained using the sklearn.metrics module of scikit-learn in Python. VADER demonstrated an overall accuracy of 0.70. For negative sentiments, it achieved a precision of 0.68, recall of 0.80, and an F1-score of 0.73, while for positive sentiments, it had a precision of 0.73, recall of 0.59, and an F1-score of 0.65. The AUC for the ROC curve was 0.90. DistilRoBERTa analysis showed that higher ratings for medication effectiveness, ease of use, and satisfaction corresponded with more positive emotional responses. These results were consistent with VADER's sentiment analysis, confirming the reliability of both models. VADER and DistilRoBERTa effectively analyzed patients' sentiments towards pharmacotherapy, providing valuable information. These findings encourage studies of SA in clinical pharmacy practice, paving the way for more personalized and effective patient care strategies.

Whole-blood RNA biomarkers for predicting survival in non-human primates following thoracic radiation

Radiation injury, either from radiotherapy or a mass-casualty event requires a health care system that can efficiently allocate resources to patients. We conducted a comprehensive transcriptome analysis of whole blood from a nonhuman primate model that received upper thoracic radiation (9.8–10.7 Gy). Blood samples were collected at multiple time points, extending up to 270 days post-irradiation with a minimum n = 6 for initial time points (Day 3-Day 40) and a total number of n = 28 primates. No males receiving the higher dose survived to Day 270. Using the Elastic Net model in R we found that pooling biomarkers from Day 3–21 increased our accuracy in discerning survival time, pleural effusion or dose compared to using biomarkers specific to a single day. For survival data, in predicting short term (less than 90 day), medium term (Day 91–269) or long-term survival (Day 270), prediction accuracy using only Day 3 data was 0.14 (95% Confidence Interval (CI) 0.1, 0.19) while pooled data for Male and Female was 0.76 (CI 0.69, 0.82). When pooled data was divided by biological sex, accuracy was 0.7 (CI 0.58, 0.8) for pooled data from Males and 0.84 (CI 0.76, 0.91) for Females. The development of RNA biomarkers as a tool to aid in clinical decision-making could significantly improve patient care in cases of radiation injury, whether from radiotherapy or mass-casualty events. Further validation and clinical translation of these findings could lead to improved patient care and management strategies in cases of radiation exposure.

Exploring Emotional Well-Being and Support of Midwives Who Provide Termination of Pregnancy Care: An International Survey.

Assess the psychological impact that providing TOP care beyond 12 weeks gestation has on midwives in Australia and New Zealand, improve understanding of TOP care and explore what support midwives have and what they might need to deal with their work experiences. Online survey. A web-based, self-reported questionnaire with a total of 63 questions collected data from June to October 2022. Two validated psychometric tools were included to assess emotional well-being. Numerical data were analysed using descriptive statistics, frequencies, percentages and means. The STROBE guideline was used for reporting. Most midwives felt unsupported and affected by their experiences of providing termination of pregnancy care. Recognition and regular post-care debriefing with management were minimal. Lack of staff impacted the ability to provide individualised care. Mental health support was not commonly offered to midwives. Psychometric tools showed burnout and high levels of compassion fatigue, but also compassion satisfaction. To feel supported midwives need a fully staffed workforce, the ability to provide one-on-one care, recognition from managers and team support. Midwives who deliver termination of pregnancy care are unsupported and at high risk of burnout and compassion fatigue. Providing appropriate support is vital to increase midwives' well-being and sustain women's access to safe, high-quality care. Study addresses a knowledge gap about midwives' support needs when caring for women undergoing termination of pregnancy beyond 12 weeks. Findings show the urgent need to recruit and retain midwifery staff, acknowledge the mental health risks of termination of pregnancy care and implement mental health strategies for midwives. Research benefits midwives who provide termination of pregnancy care, midwife managers, healthcare organisations and professional bodies. No patient or public involvement.

Innovative Approaches to Strengthening Preventative Care in Contemporary Healthcare: A Systematic Review

Preventative care plays a critical role in reducing disease burden, improving patient outcomes, and lowering healthcare costs in contemporary medicine. However, the effective implementation of preventative care strategies faces numerous challenges, including technological, financial, and social barriers. This systematic review explores innovative approaches aimed at strengthening preventative care in modern healthcare systems. Key innovations include the use of telemedicine, artificial intelligence (AI), personalized medicine, and community-based public health initiatives. Telemedicine and AI have revolutionized early detection and risk assessment, while personalized medicine and genomic screening allow for tailored preventative interventions. Additionally, behavioral economics and health education programs have proven effective in promoting healthier lifestyles and improving adherence to preventative measures. The review evaluates the impact of these innovations on patient outcomes and highlights both the benefits and challenges of implementing these approaches. While the advancements offer promising results, further research is needed to address issues related to equity, ethical concerns, and global applicability. This review provides valuable insights for healthcare providers, policymakers, and researchers looking to enhance the effectiveness of preventative care strategies in contemporary healthcare systems.

Excess mortality and suicide risk in treatment-seeking individuals with schizotypal disorder: A population-based study using Swedish national registers

This study investigates the excess mortality, both all-cause and due to suicide, among individuals with schizotypal disorder (SD) compared to the general population. Using individual-level data from the Swedish National Patient Register and the Cause of Death Register, we analyzed mortality in 998 patients diagnosed with SD from 2006 to 2017. Our primary outcomes were all-cause mortality and suicide mortality, with baseline variables including sex, age, and psychiatric comorbidities. Results indicated significantly elevated mortality rates for both all-cause mortality (Standardized Mortality Ratio (SMR) 5.2) and suicide (SMR 23.4). Substance use disorders, personality disorders, and ADHD were identified as significant predictors of increased all-cause mortality. Notably, having a personality disorder in conjunction with schizotypal disorder resulted in a markedly increased risk of suicide. The study underscores the urgent need for targeted interventions and improved diagnostic precision to reduce premature mortality in this vulnerable population. Additionally, the relatively low prevalence of SD diagnoses in Sweden highlights a potential underdiagnosis or misclassification issue. These findings have critical implications for clinical practice and public health efforts, emphasizing the necessity for comprehensive care strategies and suicide prevention interventions to improve outcomes for individuals with schizotypal disorder.

Evolving Role of Coronary Collaterals in STEMI Outcomes: A Comparative Analysis of Pandemic and Post-Pandemic Phases.

Acute ST-elevation myocardial infarction (STEMI) is a critical condition where coronary collaterals can mitigate myocardial damage. The Coronavirus Disease 2019 (COVID-19) pandemic introduced unique challenges in STEMI management, potentially affecting outcomes. This study evaluates the efficacy of coronary collaterals during the pandemic compared to the post-pandemic period. A review of 1465 STEMI patients treated at a high-volume tertiary care center from April 2020 to December 2022 was conducted. Collaterals were assessed using the Rentrop classification. In-hospital mortality and 1-year major adverse cardiac events (MACE) were analyzed based on collateral status and timeframes. During the pandemic, there was a higher incidence of robust collaterals (28.2% vs 23.2%, P = .04), but they were less protective, with similar in-hospital mortality (14.4% vs 8.1%, P = .07) and 1-year MACE rates (21.9% vs 30.4%, P = .09) across groups. Post-pandemic, robust collaterals showed significant protective effects with reduced in-hospital mortality (3.6% vs 7.4%, P = .04) and 1-year MACE rates (17.1% vs 24.9%, P = .03). These findings highlight a dynamic role of collaterals in STEMI management, with the pandemic impairing their functionality. This underscores the need for adaptive STEMI care strategies, especially during global health crises.

Emerging technologies in regenerative medicine: The future of wound care and therapy.

Wound healing, an intricate biological process, comprises orderly phases of simple biological processed including hemostasis, inflammation, angiogenesis, cell proliferation, and ECM remodeling. The regulation of the shift in these phases can be influenced by systemic or environmental conditions. Any untimely transitions between these phases can lead to chronic wounds and scarring, imposing a significant socio-economic burden on patients. Current treatment modalities are largely supportive in nature and primarily involve the prevention of infection and controlling inflammation. This often results in delayed healing and wound complications. Recent strides in regenerative medicine and tissue engineering offer innovative and patient-specific solutions. Mesenchymal stem cells (MSCs) and their secretome have gained specific prominence in this regard. Additionally, technologies like tissue nano-transfection enable in situ gene editing, a need-specific approach without the requirement of complex laboratory procedures. Innovating approaches like 3D bioprinting and ECM bioscaffolds also hold the potential to address wounds at the molecular and cellular levels. These regenerative approaches target common healing obstacles, such as hyper-inflammation thereby promoting self-recovery through crucial signaling pathway stimulation. The rationale of this review is to examine the benefits and limitations of both current and emerging technologies in wound care and to offer insights into potential advancements in the field. The shift towards such patient-centric therapies reflects a paradigmatic change in wound care strategies.

Prognostic significance of CD3+ and CD8+ T-cells immunoscore in renal cell carcinoma: Comparison between two simple models for assessment

The immunoscore (ISc) has been extensively investigated as a prognostic indicator for numerous solid tumors. In renal cell carcinoma (RCC), its prognostic significance has been evaluated in a small number of studies. This study was designed to ascertain the predictive value of immunoscore based on CD3+ and CD8+ T cells in patients with RCC. This study included 115 non-metastatic RCC patients who underwent nephrectomy. The ISc was obtained by estimating the densities of CD3+ and CD8+ cells at the invasive margin and center of the tumor using two methods: cell count per square millimeter (cell count/mm2) and percentage of cells per square millimeter (% of cells/mm2). The patients were categorized into low and high groups according to the ISc. The associations between the ISc and clinicopathological characters, including survival, were analyzed statistically. Adverse clinicopathologic factors were significantly associated with high ISc. Patients with high ISc had significantly worse overall survival (OS) and disease-free survival (DFS) rates over three years (p < 0.001). High ISc was considered a predictor of shortened DFS in univariate analysis (p < 0.001). However, in multivariate analysis, it was a dependent predictor. High ISc could help identify individuals more likely to develop recurrence and may impact treatment strategy for more effective personalized care. Moreover, establishing a modified objective, automated, digital quantification method of immune cells (% of cells/mm2 instead of cell count/mm2) is expected to be simple to implement in routine, highly affordable, time efficient, clinically meaningful, and will improve assay performance.

Multifunctional poloxamer-based thermo-responsive hydrogel loaded with human lactoferricin niosomes: In vitro study on anti-bacterial activity, accelerate wound healing, and anti-inflammation

Chronic wound infections are attributed to delayed tissue repair, which remains a major clinical challenge in long-term health care. Particularly, infections with antibiotic resistance have more serious effects on health, often resulting in unsuccessful treatments. Thus, antimicrobial peptide (AMP)-based therapy holds promise as a potential therapeutic approach to overcoming drug resistance. Conventional wound dressing is a passive strategy for wound care that is not capable of eradicating pathogens and promoting tissue repair. In this study, we aim to construct an advanced wound dressing; a thermo-responsive hydrogel incorporated with lactoferricin (Lfcin) niosome (Lfcin-Nio/hydrogel) for bacterial pathogen treatment. The Lfcin-loaded niosome (Lfcin-Nio) has a particle size of 396.91 ± 20.96 nm, 0.38 ± 0.01 of PdI, −10.5 ± 0.3 mV of ζ potential, and 72.30 ± 7.05 % Lfcin entrapment efficiency. Lfcin-Nio exhibited broad antibacterial activity on both drug-susceptible and drug-resistant strains, and also on bacteria residing in the biofilm matrix. The Lfcin-Nio/hydrogel was fabricated from 0.5 % w/v poloxamer 188–20 % w/v poloxamer 407, and supplemented with Lfcin-Nio and epidermal growth factor (EGF). The physical properties of Lfcin-Nio/hydrogels showed elasticity, swelling ability, and strong injectability with responsiveness to 33–37 °C temperatures. The biological properties of Lfcin-Nio/hydrogels exhibited a bactericidal effect against drug-resistant strains of S. aureus and P. aeruginosa, and showed less toxicity to the human skin fibroblast. It also promoted the healing of scratches by 55 % within 6 h, compared to the wound closure rate of 20 % in the cell control. The inflammatory response of the Lfcin-Nio/hydrogel-treated cells was reduced via suppression of IL-1β and COX-2 mRNA expressions. From this study, Lfcin-Nio/hydrogels can be suggested as a modern wound dressing that possesses multifunctional and beneficial properties for the management of chronic wound infections.

Discrimination and manic symptoms in early adolescence: A prospective cohort study

PurposeThis study aims to investigate the prospective associations between four types of perceived discrimination (country of origin, race and ethnicity, sexual orientation, and weight) and the development of manic symptoms in a diverse, nationwide sample of adolescents aged 9–14 years in the U.S. MethodsWe analyzed prospective cohort data from the Adolescent Brain Cognitive Development Study (N = 7466; ages 9–14 years at Year 1 or 2 in 2017–2020; 49.1 % female; 42.1 % racial/ethnic minority). Multiple zero-inflated negative binomial analyses were conducted to examine the associations between Year 1 or 2 discrimination (by country of origin, race/ethnicity, sexual orientation, weight, sum score), and Year 3 manic symptoms (7 Up Mania scale), adjusting for covariates (age, sex, race/ethnicity, household income, parental education, sipping alcohol, puffing tobacco, anxiety symptoms, depressive symptoms, Year 1 manic symptoms, and study site). ResultsAfter adjusting for covariates, perceived discrimination based on country of origin (incidence rate ratio [IRR] = 1.46; 95 % confidence interval [CI] 1.15–1.86), sexual orientation (IRR = 1.36; 95 % CI 1.21–1.53), race/ethnicity (IRR = 1.28; 95 % CI 1.13–1.46), weight (IRR = 1.21 95 % CI 1.09–1.34), and sum scores (IRR = 1.18 5 % CI 1.12–1.24), were significantly associated with higher manic symptoms. ConclusionPerceived discrimination based on country of origin, race/ethnicity, sexual orientation, weight, and sum scores, are prospectively associated with greater manic symptoms in adolescents. These findings underscore the need for targeted interventions to address discrimination and associated psychological impacts. Efforts to reduce discrimination and to support affected adolescents are important components of comprehensive mental health care and public health strategies.

Diabetic Neuropathy: A Guide to Pain Management.

Diabetic neuropathy is a common complication of diabetes mellitus (DM) and can affect up to 50% of DM patients during their lifetime. Patients typically present with numbness, tingling, pain, and loss of sensation in the extremities. Since there is no treatment targeting the underlying mechanism of neuropathy, strategies focus on preventative care and pain management. Up to 69% of patients with diabetic neuropathy receive pharmacological treatment for neuropathic pain. The United States Food and Drug Administration (FDA) confirmed four drugs for painful diabetic neuropathy (PDN): pregabalin, duloxetine, tapentadol, and the 8% capsaicin patch. Nonpharmacological treatments such as spinal cord stimulation (SCS) and transcutaneous electrical nerve stimulation (TENS) both show promise in reducing pain in DM patients. Despite the high burden associated with PDN, effective management remains challenging. This update covers the background and management of diabetic neuropathy, including its epidemiology, pathogenesis, preventative care, and current therapeutic strategies.

Investigation of Photoinduced Deterioration in Shadow Puppet Artifacts Collected from the National Shadow Pupperty Museum in Chengdu, China

Shadow puppet artifacts are a special type of cultural heritage made from animal skin, possessing significant cultural and artistic value. However, there is insufficient attention to the scientific preservation of these artifacts, and systematic research on their protection is lacking. In particular, light as an important factor and related conservation studies are weak. This study investigates the photoinduced deterioration of shadow puppet artifacts from the National Shadow Pupperty Museum in Chengdu collection. Based on the xenon arc lamp are a common method of light aging, the modern rawhide samples were aged by the xenon arc lamp to simulate photoinduced deterioration. After artificial light aging, the samples were stored in a stable environment (with temperature maintained at 22 ± 2°C and relative humidity maintained at 50 ± 5%RH) for 150 days. It attempts to avoid further deterioration of the samples due to drastic cyclic changes in the environment. And continuously observe changes in characteristics during this process to verify the potential reversibility of photoinduced deterioration. Comprehensive assessments were conducted to gauge the extent of deterioration. In order to assess the deterioration, a series of analytical techniques were used. Moisture gain or loss was inferred from mass changes, and colorimetric measurements were measured using the CIELAB formula. Macroscopic and microscopic morphological damage was documented through camera, stereo microscope, and scanning electron microscope observations. Fourier transform infrared spectroscopy (FTIR) assessed amide bond degradation and moisture loss, while thermogravimetry/differential thermogravimetry (TG/DTG) evaluated collagen denaturation and thermal stability. The results indicated that prolonged light exposure caused significant deterioration, including color fading, moisture evaporation, and structural damage such as shrinkage and cracking. The findings indicate that light exposure is a crucial factor in the preservation of shadow puppet artifacts. Therefore, it is essential to implement careful management strategies in museum environments to ensure the protection of these artifacts.

ABodyBuilder3: improved and scalable antibody structure predictions.

In this article, we introduce ABodyBuilder3, an improved and scalable antibody structure prediction model based on ABodyBuilder2. We achieve a new state-of-the-art accuracy in the modelling of CDR loops by leveraging language model embeddings, and show how predicted structures can be further improved through careful relaxation strategies. Finally, we incorporate a predicted Local Distance Difference Test into the model output to allow for a more accurate estimation of uncertainties. The software package is available at https://github.com/Exscientia/ABodyBuilder3 with model weights and data at https://zenodo.org/records/11354577.

Antimicrobial effects of a multimodal wound matrix against methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa in an in vitro and an in vivo porcine wound model.

Chronic non-healing wounds pose significant challenges due to an elevated inflammatory response caused in part by bacterial contamination (Physiol Rev. 2019;99:665). These wounds lead to billions being spent in the health care system worldwide (N Engl J Med. 2017;376:2367, Int J Pharm. 2014;463:119). We studied the in-vitro and in-vivo antimicrobial effects of a multimodal wound matrix (MWM) against two common wound pathogens, Methicillin-Resistant Staphylococcus aureus (MRSA USA300) and Pseudomonas aeruginosa ATCC 27312 (PA27312) (Int Wound J. 2019;16:634). The in-vitro study conducted was a zone of inhibition test with the two microbes at 104 Log CFU/mL inoculated on Tryptic soy agar with 5% sheep blood (TSAII) plates. Treatments used were MWM, Mupirocin (Positive control for MRSA), Silver Sulfadiazine (Positive Control for PA), Petrolatum and Sterile Saline (both serving as Negative Controls). Treatments were allowed to diffuse into the agar for 3 h and then were incubated for 24 h at 37°C. The in-vivo study utilized a deep dermal porcine wound model (22 × 22 × 3 mm) created on six animals. Three animals were inoculated with MRSA USA300 and the other three with PA27312 with each allowing a 72-h biofilm formation. After 72 h, baseline wounds were assessed for bacterial concentration and all remaining wounds were treated with either MWM alone, Silver Treatment or Untreated Control. Wounds were assessed on days 4, 8 and 12 after treatment application for microbiological analysis. In-vitro, MWM exhibited significant inhibition of MRSA USA300 and PA27312 growth when compared to negative controls (p ≤ 0.05). Likewise, in-vivo, the MWM-treated wounds exhibited a significant (p ≤ 0.05) bacterial reduction compared to all other treatment groups, especially on days 8 and 12 for both pathogens. MWM demonstrated promise in addressing colonized wounds with biofilms. Additional studies on MWM's benefits and comparisons with existing treatments are warranted to optimize wound care strategies (Adv Wound Care. 2021;10:281).

Early Mobilization Training Education for Sectio Caesarea Patients

Background: The global rise in caesarean section (C-section) rates, particularly in Asia where the incidence stands at 19.5%, underscores the need for effective post-operative care strategies. Early mobilization is critical for post-C-section recovery, as it enhances patient mobility, reduces complications, and promotes overall health. Purpose: This study aims to assess the impact of early mobilization education on post-C-section patients' knowledge. Methods: This community service initiative, conducted at the Albarokah Room of Purwokerto Islamic Hospital, targeted 30 post-C-section maternal patients. The educational intervention was delivered using audiovisual media and the caramah method. Knowledge levels were assessed using a pre- and post-intervention questionnaire, which evaluated understanding of early mobilization, its benefits, contraindications, and procedural stages. Findings: Prior to the educational intervention, participants' knowledge was predominantly categorized as poor, with 40% (12 participants) scoring in this range. Post-education assessment revealed a significant improvement, with 100% (30 participants) achieving a good knowledge level regarding early mobilization. Conclusions: The implementation of early mobilization education through audiovisual media markedly improved participants' knowledge about early mobilization post-C-section. This study demonstrates that structured educational interventions can effectively enhance patient understanding and potentially improve post-operative outcomes. Further research is warranted to explore long-term effects on recovery and health

Dietary habit and lifestyle of postpartum women in South China: a mixed methods research

ObjectiveTo investigate the dietary and hygiene behaviours and influencing factors of women during the puerperium in South China.DesignA cross-sectional study.SettingThree tertiary hospitals in Guangdong Province, ChinaParticipantsFrom November 2022 to March...

Call for Research: Leveraging Social Networking for Modern Slavery &amp; Human Trafficking Awareness

ABSTRACTHuman trafficking is a complex global issue that continues to challenge efforts aimed at raising awareness and preventing its occurrence. Overall, the literature suggests that social networking platforms have the potential to significantly enhance human trafficking awareness efforts but require careful strategy development to overcome algorithmic limitations and ensure meaningful engagement with users. Further research is needed to evaluate the long‐term impact of social networking campaigns on human trafficking awareness and prevention. This poster is an extension of a presentation at the ASIS&amp;T Midwest Chapter Spring 2024 Symposium with the purpose of increasing attention to this important research area. This poster provides five broad research questions that can be immediately addressed by information science researchers for the purpose of increasing understanding of this devastating global issue.

Leveraging electronic medical record (EMR) changes and virtual care towards improving tobacco screening and referral rates.

426 Background: Continued smoking after a cancer diagnosis is associated with poorer outcomes. Ontario Regional Cancer Centres are required to screen all new cancer patients for tobacco use and offer referrals for cessation support to patients using tobacco. At Princess Margaret Cancer Centre (Toronto, Canada), we leveraged an EMR change to Epic along with uptake in virtual care strategies from COVID-19, to improve both tobacco screening and referral rates for new patients. Methods: Following the EMR transition to Epic in June 2022, we piloted EMR and virtual care strategies from Jan 2023 to Mar 2024 to improve both tobacco screening and referral rates. Due to precautions during COVID-19, screening and referrals were completed using a hybrid pre-visit electronic tobacco use assessment questionnaire and in clinic paper-based referral system. Our interventions were co-developed by a team of hospital leadership, IT team members and clinicians. These included: 1) Collation of tobacco assessment data sources on Epic (Jan 2023); 2) Creation of an Epic referral inbox to track referrals (Aug 2023); 3) Assignment of electronic pre-visit tobacco assessments questionnaires to correct visit types (Sep 2023); 4) Creation of a half-day virtual nursing clinic to offer referrals for cessation support to patients initially declining support or those who were not offered using monthly reports from Epic (Nov 2023). Screening and referral rates were tracked monthly and quarterly during this period. Results: From Jan 2023 to March 2024, 15,063 new patients presented to our cancer centre. Baseline screening and referral rates before COVID-19 were 47% and 16%, respectively. Prior to this QI initiative, screening and referral rates were 18% and 1%, respectively. Post implementation, screening and referral rates improved to 42% and 25% (Table); rates of current tobacco use remained consistent from 12-16%. Collation of tobacco use assessments data on Epic had the greatest impact on improving screening rates from 18% to 39% (p&lt;0.001), while the virtual nursing clinic helped to improve referral rates from 3% to 25% (p&lt;0.001), with the greatest referral rate in Jan 2024 at 36%. Our virtual nursing clinic was feasible, where among patients contacted who initially declined or were not offered cessation support, 90% were contacted within 1-3 phone calls. Among patients contacted, 20% accepted a referral, while 41% of patients had already quit smoking by the time of contact. Conclusions: Both EMR and virtual care strategies helped to successfully improve both tobacco screening and referral rates for smoking cessation support; with the greatest impact from the collation of EMR data sources on tobacco use and development of a virtual nurse led clinic. Quarterly tobacco screening and referral rates. Jan-Mar 2023 Apr-Jun 2023 Jul-Sep 2023 Oct-Dec 2023 Jan-Mar 2024 Screening 33% 38% 39% 41% 42% Referrals 0% 1% 3% 20% 25%

Exploration of the potential association between newer antiseizure medications and arrhythmias: Integrating pharmacovigilance and bioinformatics evidence

IntroductionArrhythmias resulting from newer antiseizure medications (ASMs) may significantly impact the safety and quality of life of patients with epilepsy. This study investigated the potential association between new first-line or second-line ASMs and arrhythmias. MethodsPharmacovigilance analysis was conducted using data from the Food and Drug Administration Adverse Event Reporting System (FAERS) from 2004 to 2023. A disproportionality analysis was performed to compare newer ASMs with other drugs, using carbamazepine and valproate as positive controls. Newer ASMs were categorized into sodium channel (SCN) main mechanism, SCN possible mechanism, and non-SCN group. The bioinformatics analysis involved retrieving therapeutic gene targets for ASMs from the DrugBank and OMIM databases, as well as identifying arrhythmia disease targets from the GeneCards database. Additionally, enrichment analysis of gene ontology functions and KEGG pathways was conducted. ResultsA total of 3,457 cases of arrhythmias associated with newer ASMs were identified in the FAERS database. Disproportionality analysis indicates that brivaracetam (IC025 = 0.08), zonisamide (IC025 = 0.13), eslicarbazepine (IC025 = 0.39), and lacosamide (IC025 = 0.84) exhibited a positive signal for arrhythmias, with signals predominantly observed in the SCN main mechanism group. Furthermore, bioinformatics analysis revealed the involvement of adrenergic signaling in cardiac myocytes, as well as the participation of sodium channel genes in ASM-induced arrhythmias. ConclusionOur findings suggest a potential association between SCN-ASMs and arrhythmias, highlighting the importance of monitoring and evaluating the safety profiles of newer ASMs in clinical practice. Further research is necessary to elucidate the underlying mechanisms and inform patient care strategies.

Prevalence of depression among drug-resistant tuberculosis patients in South Asia: A systematic review and meta-analysis

Background: Drug-resistant tuberculosis (DR-TB) significantly increases the risk of depression, yet research on mental health in this population remains limited. Aim: This meta-analysis aimed to evaluate the prevalence of depression among multidrug-resistant TB (MDR-TB) patients, emphasizing the necessity for integrated mental health care. Methods: A systematic search across PubMed, Cochrane, EBSCOhost, and Google Scholar identified 536 articles, which were screened for eligibility after removing duplicates. Prevalence data were analyzed using R programming, with back-transformation applied to enhance accuracy. The methodological quality of the included studies was assessed with the JBI Critical Appraisal Checklist, and the study protocol is registered in PROSPERO (CRD42023449156). Results: Ultimately, twelve studies involving 3,258 participants were included in the analysis. The pooled prevalence of depression among MDR-TB patients was found to be 54% (95% CI: 42%-65%). Although substantial heterogeneity was noted (I² = 72%; P &lt; 0.01), excluding one study (Walker et al.) due to high Cook’s distance revised the prevalence to 55% (95% CI: 43%-68%), with reduced heterogeneity (I² = 68%; P &lt; 0.01). Subgroup analyses indicated minimal variability among studies using the Hamilton Depression Rating Scale (52%, 95% CI: 40%-64%) and substantial variability among those employing the Patient Health Questionnaire (54%, 95% CI: 30%-79%). Funnel plot analysis and Egger’s test revealed no significant publication bias (P = 0.2105). Conclusion: This study highlights a high prevalence of depression among MDR-TB patients, underscoring the urgent need for integrated mental health care strategies tailored for this vulnerable population. Further research is essential to refine these strategies effectively.