Medical Utilization Research Articles

Healthcare costs and medical utilization patterns associated with painful and severe painful diabetic peripheral neuropathy.

Painful diabetic peripheral neuropathy (DPN) is a common complication in patients with diabetes. It is associated with a poor quality of life and high costs of care. This study investigated the impact of painful DPN on healthcare costs and resource utilization. This was a retrospective analysis of administrative claims of adult patients with diabetes (type 1 or 2) from Optum's de-identified Clinformatics® Data Mart Database. Patients were assigned to four cohorts by presence of DPN and pain severity, based on diagnoses and prescription patterns in a one-year baseline. All-cause and diabetes-associated costs were calculated for the year following the index DPN diagnosis. Risk factors associated with presence of severely painful DPN were evaluated. Relative to those without DPN, patients who had DPN without pain, painful DPN (PDPN), or severe PDPN incurred respective increases of $3,093, $9,349, and $20,887 in average annual all-cause costs. More than half of costs from painful/severe DPN were for prescriptions and inpatient hospitalization. Severe PDPN was associated with elevated odds of diabetic amyotrophy (OR: 8.09; 95% CI: 6.84-9.56), diabetic foot ulcers (OR: 6.54, 95% CI: 6.32-6.76), and loss of mobility (OR: 2.54, 95% CI: 2.48-2.60), among other complications. Painful DPN is associated with higher healthcare costs and resource utilization, and a greater risk of debilitating conditions that limit quality of life. Future research should focus on better treatment options and more aggressive pain management strategies to reduce the negative impacts of DPN.

T61 - Utilization of Medication for Opioid Use Disorder for Hospitalized Patients at 6 New York City Public Hospitals With an Addiction Consultation Service

T61 - Utilization of Medication for Opioid Use Disorder for Hospitalized Patients at 6 New York City Public Hospitals With an Addiction Consultation Service

A national survey of medication utilization for cardiac resuscitation in the emergency department: A survey of emergency medicine pharmacists.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Vasoactive medications are used during advanced cardiac life support (ACLS) to shunt oxygenated blood to vital organs and after return of spontaneous circulation (ROSC) to maintain hemodynamic goals. However, limited evidence exists to support vasoactive medication recommendations in such scenarios, and it is unknown how practices vary among emergency departments across the US. A survey questionnaire (15 questions) was electronically distributed to emergency medicine pharmacists (EMPs) in the US through various professional listservs. Demographic information, American Heart Association ACLS algorithm medication use, and use of continuous vasopressor infusions and adjunct medications following ROSC were assessed and are reported descriptively. The survey was distributed to 764 EMPs, with a 23% response rate from a wide geographic distribution and 48% of respondents practicing in academic medical centers. Epinephrine dosing and administration during cardiac arrest were reported by most to be in accordance with ACLS cardiac arrest algorithms. Calcium, magnesium sulfate, and sodium bicarbonate were the most common adjunct intravenous medications given during cardiac arrest. Norepinephrine was the first-choice vasopressor (81%) for post-ROSC hypotension, while epinephrine was preferred less frequently (17%). Antibiotics and sodium bicarbonate were the most frequently administered post-ROSC adjunct medications. This survey of a geographically diverse group of EMPs demonstrated high ACLS algorithm adherence for epinephrine during cardiac arrest with frequent additional administration of nonalgorithm medications. Sodium bicarbonate and calcium were the most frequently administered adjunct medications during cardiac arrest, while sodium bicarbonate and antibiotics were the most frequently used adjunct medications following ROSC. Norepinephrine was the most commonly used vasopressor following ROSC.

Household economic costs of norovirus gastroenteritis in two community cohorts in Peru, 2012-2019.

While costs of norovirus acute gastroenteritis (AGE) to healthcare systems have been estimated, out-of-pocket and indirect costs incurred by households are not well documented in community settings, particularly in developing countries. We conducted active surveillance for AGE in two communities in Peru: Puerto Maldonado (October 2012-August 2015) and San Jeronimo (April 2015-April 2019). Norovirus AGE events with PCR-positive stool specimens were included. Data collected in follow-up interviews included event-related medical resource utilization, associated out-of-pocket costs, and indirect costs. There were 330 norovirus-associated AGE events among 3,438 participants from 685 households. Approximately 49% of norovirus events occurred among children <5 years of age and total cost to the household per episode was highest in this age group. Norovirus events cost a median of US $2.95 (IQR $1.04-7.85) in out-of-pocket costs and $12.58 (IQR $6.39-25.16) in indirect costs. Medication expenses accounted for 53% of out-of-pocket costs, and productivity losses accounted for 59% of the total financial burden on households. The frequency and associated costs of norovirus events to households in Peruvian communities support the need for prevention strategies including vaccines. Norovirus interventions targeting children <5 years of age and their households may have the greatest economic benefit.

Prior emergency medical services utilization is a risk factor for in-hospital death among patients with substance misuse: a retrospective cohort study

BackgroundSubstance misuse poses a significant public health challenge, characterized by premature morbidity and mortality, and heightened healthcare utilization. While studies have demonstrated that previous hospitalizations and emergency department visits are associated with increased mortality in patients with substance misuse, it is unknown whether prior utilization of emergency medical service (EMS) is similarly associated with poor outcomes among this population. The objective of this study is to determine the association between EMS utilization in the 30 days before a hospitalization or emergency department visit and in-hospital outcomes among patients with substance misuse.MethodsWe conducted a retrospective analysis of adult emergency department visits and hospitalizations (referred to as a hospital encounter) between 2017 and 2021 within the Substance Misuse Data Commons, which maintains electronic health records from substance misuse patients seen at two University of Wisconsin hospitals, linked with state agency, claims, and socioeconomic datasets. Using regression models, we examined the association between EMS use and the outcomes of in-hospital death, hospital length of stay, intensive care unit (ICU) admission, and critical illness events, defined by invasive mechanical ventilation or vasoactive drug administration. Models were adjusted for age, comorbidities, initial severity of illness, substance misuse type, and socioeconomic status.ResultsAmong 19,402 encounters, individuals with substance misuse who had at least one EMS incident within 30 days of a hospital encounter experienced a higher likelihood of in-hospital mortality (OR 1.52, 95% CI [1.05 – 2.14]) compared to those without prior EMS use, after adjusting for confounders. Using EMS in the 30 days prior to an encounter was associated with a small increase in hospital length of stay but was not associated with ICU admission or critical illness events.ConclusionsIndividuals with substance misuse who have used EMS in the month preceding a hospital encounter are at an increased risk of in-hospital mortality. Enhanced monitoring of EMS users in this population could improve overall patient outcomes.

Smoking cessation rate and predictors of successful quitting in Jordan: A cross-sectional study.

Tobacco smoking in Jordan is the highest in the Middle East, with health consequences and economic burdens. Smoking cessation improves health and grows the economy. This study aimed to determine the prevalence of smoking cessation in Jordan and to identify the determinants of effective quitting. This cross-sectional study was conducted using an online survey directed towards the general population of Jordan. The questionnaire was formulated in Arabic and inquired about sociodemographic factors, health status, behaviors, smoking habits, previous quitting attempts, utilization of smoking cessation services, attitudes towards quitting, and barriers to quitting. Data were analyzed using Statistical Package for Social Science version 25. A total of 463 participants were included in this study. Twenty-one percent of them were ex-smokers (n = 97), 86% were male, 63.3% were from the middle governorates, and 29.2% were 24 years old or younger. The rate of sustained quitting for at least 3 months among participants was 13.6%. The factors associated with successful quitting included age > 50 years (P = .001), practicing regular physical activity (P = .003), using more than 1 tobacco product (P = .000), smoking waterpipes or e-cigarettes (P = .000 and .015, respectively), lower levels of nicotine dependence (P = .009), duration of smoking (P = .000), higher number of smoking cessation attempts (P = .000), having 1 or more chronic diseases (P = .049), and having DM (P = .003). More than half of the ex-smokers needed 2 to 5 attempts before successfully quitting smoking. There was a low rate of utilization of smoking cessation services and medications in both groups. On the other hand, there is a high rate of use of other smoking methods, particularly waterpipes and e-cigarettes, as an aid for quitting. Current smokers reported being in a stressful situation as a barrier to quitting significantly more often than did ex-smokers (P = .013). Both groups had moderately positive attitudes toward quitting. Ex-smokers had significantly better attitudes toward their ability to manage stress, weight gain, and increased appetite after quitting (P = .004, .004, and .007, respectively). This study provides valuable insights into the complex dynamics of smoking behavior, cessation attempts, and attitudes. These findings can inform the development of targeted smoking cessation programmes and policies.

Cardiovascular risk and subclinical atherosclerosis in first-degree relatives of patients with premature cardiovascular disease

BackgroundScreening first-degree relatives (FDRs) of patients with premature coronary artery disease (CAD) is recommended but not routinely performed. ObjectivesTo assess the diagnostic yield and impact on clinical management of a clinical and imaging-based screening program of FDRs delivered in the setting of routine clinical care. MethodsWe recruited FDRs of patients with premature CAD with no personal history of CAD and prospectively assessed for: 1) cardiovascular risk and presence of significant subclinical atherosclerosis (SA) defined as plaque on carotid ultrasound, stenosis >50% or extensive atherosclerosis on coronary computed tomography angiography, or coronary artery calcium scores >100 Agatston units or >75% percentile for age and sex; 2) utilization of preventive medications and lipid levels prior enrolment and after completion of the assessment. ResultsWe assessed 132 FDRs (60.6% females), mean (SD) age 47(17) years old. Cardiovascular risk was high in 38.2%, moderate in 12.2%, and low in 49.6% of FDRs. SA was present in 34.1% of FDRs, including 12.5% in low, 51.9% in moderate, and 55.0% in high calculated risk groups. After assessment, LLT was initiated in 32.6% of FDRs and intensified in 16.0% leading to mean (SD) LDL-C decrease of 1.07(1.10) mmol/L in patients with high calculated risk or SA. LLT was recommended to all patients with high calculated risk, but those with SA were more likely to receive the medications from pharmacies (93.3% vs 60.0%, p = 0.006). ConclusionScreening the FDRs of patients with premature CAD is feasible, may have high diagnostic yield and impact risk factor management.

Assessing the Clinical Efficacy of Therapeutic Drug Monitoring for Risperidone and Paliperidone in Patients with Schizophrenia: Insights from a Clinical Data Warehouse.

This study investigated the usage patterns and impact of therapeutic drug monitoring (TDM) for risperidone and paliperidone in patients diagnosed with schizophrenia, utilizing retrospective real-world data sourced from a single center's Clinical Data Warehouse. Our study cohort comprised patients diagnosed with schizophrenia undergoing treatment with either risperidone or paliperidone. Data on demographic characteristics, comorbidities, medication utilization, and clinical outcomes were collected. Patients were categorized into two groups: those undergoing TDM and those not undergoing TDM. Additionally, within the TDM group, patients were further stratified based on their risperidone and paliperidone concentrations relative to the reference range. The findings revealed that patients in the TDM group received higher risperidone and paliperidone doses (320 mg/day and 252 mg/day, p = 0.0045) compared to their non-TDM counterparts. Nevertheless, no significant disparities were observed in hospitalization rates, duration of hospital stays, or compliance between the two groups (p = 0.9082, 0.5861, 0.7516, respectively). Subgroup analysis within the TDM cohort exhibited no notable distinctions in clinical outcomes between patients with concentrations within or surpassing the reference range. Despite the possibility of a selection bias in assigning patients to the groups, this study provides a comprehensive analysis of TDM utilization and its ramifications on schizophrenia treatment outcomes.

General physicians' perspectives on SGLT2 inhibitors for heart failure.

Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are novel agents for heart failure (HF) and are now recommended in guidelines. Understanding general physicians' perspectives can help to optimise utilisation of this new medication. To understand the clinical concerns and barriers from general physicians about prescribing SGLT2is in a general medicine cohort. A questionnaire exploring clinicians' experience, comfort level and barriers to prescribing SGLT2is in patients with HF, incorporating two clinical scenarios, was disseminated to Internal Medicine Society of Australia and New Zealand members over a 2-month period. Ninety-eight participants responded to the questionnaire (10.8% response rate). Most respondents (66.3%) were senior medical staff. Most participants worked in metropolitan settings (64.3%) and in public hospital settings (83.7%). For HF with reduced ejection fraction, 23.5% of participants reported prescribing SGLT2is frequently (defined as prescribing SGLT2is frequently over 75% of occasions). For HF with preserved ejection fraction, 57.1% of participants reported prescribing SGLT2is less than 25% of the time. Almost half of the participants (44%) expressed a high level of familiarity with therapeutic knowledge of SGLT2is, while 47% indicated high familiarity with potential side effects. Patient complexity, cost of medications and discontinuity of care were identified as important barriers. Euglycemic diabetic ketoacidosis was the side effect that caused the most hesitancy to prescribe SGLT2is in 48% of the respondents. General physicians in Australia and Aotearoa New Zealand are familiar with the therapeutic knowledge and side effects of SGLT2is. Patient complexity, medication cost and discontinuity of care were significant barriers to the use of SGLT2isfor HF among general physicians.

Poster 191: Does Ischemic Preconditioning of the Operative Limb Reduce Pain after Hip Arthroscopy? A Prospective, Single Blind, Randomized Controlled Trial

Objectives: Improving pain control after hip arthroscopy is an important concern for surgeons and for optimizing the patient experience. Many surgeons use multimodal protocols including peripheral nerve blocks, oral medication, and intra-articular or local anesthetic. Identifying additional preoperative modalities for pain management is a promising way to improve pain and potentially decrease narcotic use. Ischemic preconditioning (IPC) involves the exposure of brief periods of circulatory occlusion and reperfusion which has protective effects on muscular and organ tissues. In addition, studies on the use of IPC prior to knee surgery have shown improvements in postoperative pain and decreased opioid consumption. The purpose of this study was to determine whether preoperative IPC of the operative limb affects postoperative pain scores or opioid consumption after hip arthroscopy. Methods: This is a prospective, single blind, randomized controlled trial. Patients were enrolled between October 2021 and April 2023. Inclusion criteria were patients age ≥ 18 years old undergoing hip arthroscopy by a single surgeon for hip pain in the setting of femoroacetabular impingement or labral tear. Exclusion criteria were history of venous thromboembolism or patients on medications known to increase the risk of blood clots. Following informed consent, patients were randomized to the IPC or control group and were blinded to their treatment group. Limb preconditioning was performed within 24 hours prior to surgery using the Delphi Personalized Tourniquet System (PTS) with the cuff placed on the proximal thigh of the operative limb. Patients in the IPC group received a 30-minute treatment consisting of 3 rounds of 5 minutes at limb occlusion pressure (LOP) alternating with 5 minutes of reperfusion. Patients in the control group received the same protocol at 20% LOP. Hip arthroscopy was then performed according to standard of care. All patients received a standardized preoperative and postoperative pain control regimen. Surveys were administered through RedCap daily from day of surgery through postoperative day 7. Patients were asked to rate their pain 0-10 according to the visual analog scale (VAS) for pain and to record pain medication utilization. Charts were reviewed for baseline characteristics and surgical procedures. Chi-square, independent t tests and paired t tests were used for statistical analysis. Results: A total of 64 patients (31 in the IPC group, 33 in the Control group) were enrolled. Demographics (age, sex, and body mass index) were similar between the IPC and Control groups. There was no significant difference in surgical procedures performed. Survey compliance was higher in the IPC group compared to the control group, 6.1 ± 2.8 days vs. 3.7 ± 3.4 days, respectively (p &lt; 0.05). Both groups reported significant reductions in their VAS for pain scores from day of surgery to postoperative day 6 or 7 (p &lt; 0.05). There was no significant difference between the IPC and control groups in VAS for pain scores at any of the time points from day of surgery to postoperative day 7 (Figure 1). There was also no significant difference between the groups in mean daily opioid consumption (expressed as morphine milligram equivalents) or in acetaminophen consumption at any time point. There were no early complications (within first 7 days postoperatively). Conclusions: Limb IPC does not appear to decrease pain or medication utilization after hip arthroscopy. It is possible that the pain modulating effects of IPC are not as effective when the surgical site is proximal to the site of occlusion. Other factors may have contributed to variability in the reported VAS scores, including differences in fluid extravasation, personal pain tolerances, and utilization of pain control regimen. [Figure: see text]

Temporal trends in medication and service use patterns for mental health issues among men with prostate cancer.

Prostate cancer can significantly impact mental wellbeing, creating uncertainty and morbidity. This study described patterns of psychotropic medication and mental health service use, as a proxy measure for mental health problems, 5years before and 5years after prostate cancer diagnosis. Population-based registry data were linked with Pharmaceutical Benefits Scheme and Medicare Benefits Schedule data for all prostate cancer patients diagnosed in South Australia between 2012 and 2020 (n=13,693). We estimated the proportion and rates of psychotropic medication and mental health service use before and after diagnosis. Multivariable adjusted interrupted time series analyses (ITSA) were conducted to uncover temporal patterns. Fifteen percent of men commenced psychotropic medications and 6.4% sought out mental health services for the first time after diagnosis. Psychotropic medication use rose from 34.5% 5years before to 40.3% 5years after diagnosis, including an increase in use of antidepressants (from 20.7% to 26.0%) and anxiolytics (from 11.3% to 12.8%). Mental health service use increased from 10.2% to 12.1%, with the increase mostly being general practice mental health visits (from 7.8% to 10.6%). Multivariable ITSA indicated a significant rise in medication and service utilisation immediately before and in the first 2years following prostate cancer diagnosis. There is a clear increase in psychotropic medication use and mental health service use around the time of prostate cancer diagnosis. Mental health outcomes of men with prostate cancer may be improved with early mental health screening, particularly during the diagnosis process, to enable early intervention.

Prevalence and Potential Risks Associated with Utilization of Medication During Pregnancy- A Cross-Sectional Study

Prevalence and Potential Risks Associated with Utilization of Medication During Pregnancy- A Cross-Sectional Study

KNOWLEDGE AND PERCEPTIONS OF GENERIC MEDICATIONS AMONG FINAL YEAR DIPLOMA IN PHARMACY STUDENTS IN MALAYSIA: A CROSS-SECTIONAL SURVEY

Introduction: The Diploma in Pharmacy programme in Malaysia equips students with the essential skills and knowledge to become proficient pharmacy assistants. Exploring their understanding of the knowledge and perceptions of generic medications is crucial for ensuring their readiness to contribute efficiently to healthcare settings. Methods: A cross-sectional survey was conducted using convenient sampling. This survey is designed to assess students' knowledge and perceptions of generic medications. Data was collected via Google Forms from final-year students undergoing hospital training in 13 hospitals across Malaysia. Results: The majority of participants demonstrated adequate knowledge about generic medications, scoring a mean of 3.62 (±0.537) on a 5-point Likert scale. Seventy percent of the students acknowledged the efficacy of generic medications as comparable to brand-name drugs. Moreover, students expressed confidence in distinguishing between brand-name and generic medicines, with 65.5% indicating perceived knowledge. Overall, students held positive perceptions regarding generic medications, scoring an average of 3.56 (±0.516) on the Likert scale. Conclusion: Final year Diploma in Pharmacy students in Malaysia exhibit satisfactory knowledge and positive perceptions of generic medications. This suggests that the curriculum effectively prepares students to understand and appreciate the existence of generic medication in healthcare settings. However, continuous education and reinforcement of the importance of generic medications could further help in enhancing students’ understanding and utilization of generic medications in the future.

Elamipretide protects H9c2 Rat Cardiomyoblasts against Doxorubicin-Induced Disruption of Mitochondrial Quality Control by Restoration of Fusion and Fission Balance

Doxorubicin (DOX) has been used to treat malignant diseases for over 40 years. The main constraint to its clinical application is dose-dependent cardiotoxicity which is regarded as a major matter of concern that limits its medical usefulness. Mitochondrial dysfunction is considered the chief contributor to DOX-induced cardiotoxicity and it involves disruption of mitochondrial quality control, mainly impaired fusion, and enhanced fission processes. Compounds that specifically target the mitochondria and restore fusion and fission balance are considered a promising tool to protect or treat cardiomyopathy and heart failure and thus could be investigated as a novel strategy to alleviate DOX-induced cardiac toxicity, one of which is elamipretide (ELAM). In this study, MTT assay revealed that DOX induces a significant reduction in H9c2 cell viability which is both time and dose-dependent whereas ELAM has no significant effect on the viability of the relevant cells at most of the concentrations used. Additionally, western blot analysis showed a significant reduction in the expression of fusion protein MFN2 in the DOX-treated group compared to the control (p***&lt; 0.001) whereas the fission protein DRP1 was significantly upregulated in DOX-treated cells compared to the control (p**&lt; 0.01) and normalization of both proteins was achieved when 10 µM ELAM introduced 48-hour prior to DOX therapy. In conclusion, ELAM could exert an interesting cardioprotective role against DOX-induced cardiotoxicity by restoration of mitochondrial fusion and fission balance.

Use of the Sentinel System to Examine Medical Product Use and Outcomes During Pregnancy.

While many pregnant individuals use prescription medications, evidence supporting product safety during pregnancy is often inadequate. Existing electronic healthcare data sources provide large, diverse samples of health plan members to allow for the study of medical product utilization during pregnancy, as well as pregnancy, maternal, and infant outcomes. The Sentinel System is a national medical product surveillance system that includes administrative claims and electronic health record databases from large national and regional health insurers. In addition to these data sources, Sentinel develops and maintains a sizeable selection of analytic tools to facilitate epidemiologic analyses in a way that protects patient privacy and health system autonomy. In this article, we provide an overview of Sentinel System infrastructure, including the Mother-Infant Linkage Table, parameterizable analytic tools, and algorithms to estimate gestational age and identify pregnancy outcomes. We also describe past and future Sentinel work that contributes to our understanding of the way medical products are used and the safety of these products during pregnancy.

Is Pharmaceutical Marketing Ethical?

The pharmaceutical industry is expanding, and there are many new scientific breakthroughs in the modern day. As a result, moral concerns sparked by marketing strategies have led to intense global debates. Pharmacies are trying to market their products and maintain their competitiveness, raising concerns about potential conflicts between corporate interests and the fundamentals of medical ethics. This article takes a multidisciplinary approach, incorporating public health, bioethics, and regulatory frameworks to begin a thorough investigation of the complex ethical landscape surrounding pharmaceutical marketing. The background section shows how pharmaceutical marketing methods have evolved by closely examining empirical evidence and ethical perspectives. It demonstrates how the significant move toward direct-to- consumer advertising (DTCA) has altered the healthcare industry's operations. To illustrate how intricate modern marketing strategies are, the article closely examines various techniques, including sponsorships, patient assistance programs, physician detailing, and promotional materials. The piece's primary focus is its in-depth analysis of ethics, founded on the fundamental ideas of beneficence, justice, non-maleficence, and respect for individual liberty. Pharmaceutical marketing has been scrutinized ethically for an extended period. Opponents argue that practices such as advertising and compensating doctors to promote specific treatments are considered to breach medical ethics. Advocates argue that the current methods are beneficial for education and can be ethically utilized with adequate regulation. This study examines the various perspectives in the ongoing debate. Critics argue that drug marketing results in an excessive number of prescriptions for unnecessary medications. False information about diseases is circulated to create the perception that common illnesses require pharmacological treatment. Studies indicate that exposure to marketing is associated with increased prescription rates and expenses, with no apparent health advantages for the general population. Gifts and incentives provided to doctors for marketing purposes are viewed as manipulative and compromising the impartial examination of facts. Detailers advocate for expedited utilization of new medications before their efficacy and safety profiles are fully understood. Some argue that direct-to-consumer advertising prioritizes patients' desires over doctors' professional judgment. High marketing expenses, which are transferred to prescription pricing, create obstacles for individuals to get essential medications. Associates view marketing as a way to raise awareness for overlooked disorders and educate doctors about novel therapies. Advocates of marketing argue that false advertising is against the law and that physicians rely mostly on medical research when utilizing promotions. According to polls, numerous doctors believe that marketing does not influence them. Supporters also cite evidence indicating that patients are adhering more strictly to healthcare norms, and they argue that warnings provide patients with sufficient information to make informed judgments. Profits are used to fund future research projects that must be commercialized before the patent expires. Both parties utilize substantial evidence while also depending on assumptions regarding impacts. Critics argue that the objectives of marketing are inherently unethical in contrast to evidence-based prescribing. Advocates argue that with careful supervision, appropriate utilization is achievable, albeit adjustments may be necessary. There is limited research demonstrating the definitive effects of something as either harmful or beneficial. Choosing the correct strategy remains a challenging process that requires making compromises. Creating ethically good norms requires meticulous effort to prevent misconduct while also allowing for the dissemination of knowledge. This problem warrants a thorough examination from both an empirical and normative perspective.

Review on Exploration of Phytomolecules in the Treatment of Peptic Ulcer

Peptic ulcers are defined as the presence of destructions on the mucosa of the gastrointestinal system, which might extend to the muscular layer. Their origin is complex and arises when there is a disruption in the equilibrium between the elements that cause harm and those that protect the mucosa. Peptic ulcers are a significant international health issue, impacting millions of individuals and exhibitingelevated recurrence rates. The enormous range of structural diversity and unique biological activity exhibited by natural products has significantly contributed to the creation and discovery of novel medications. An exhaustive analysis on the investigation of phytomolecules in the management of gastricabscess might offer important considerate of the existing data regarding the utilization of these compounds. This review may analyze and combine the results of several research to discover potential of phytomolecules, explain how they work, and evaluate their safety and effectiveness. This data can contribute to the advancement of efficacious and secure therapeutic alternatives for peptic ulcer. By advocating for the utilization of natural therapies and plant-based medications, the aim is to enhance the health results of individuals suffering from peptic ulcer.

Review on Recent Development in Opioid Abuse-Deterrent Formulation Technologies and Regulatory Expectation

Chronic pain occurs as a result of several diseases and ailments. The problem of improper utilization of vital opioid medication has been a topic of substantial discourse during the last two decades, in conjunction with its application for the extended-term control of persistent pain. Abuse-deterrent formulations play a crucial role in comprehensive methods to manage the risks associated with opioids. These formulations diminish the allure and narcotic properties of opioids by restricting their capacity to be assimilated by the body. This diminishes the appeal and incentives for misusing altered opioid prescriptions, and also poses challenges in extracting the opioid substance for utilization in alternative manners. This article examines various regulatory measures, projected prerequisites for the licensing of abuse-deterrent formulations, and current activities aimed at producing opioid abuse-deterrent formulations as potential remedies to combat the opioid abuse pandemic. Considering the seriousness of the global opioid problem, it is crucial for various regulatory entities to come together to safeguard society from the opioid pandemic. This involves implementing a thorough policy on prescribing opioid medications to patients, conducting evaluations to determine the likelihood of addiction, and increasing efforts to approve only opioid drugs that are specifically tailored to prevent abuse.

The association between comprehensive medication review and medication adherence among medicare beneficiaries with chronic obstructive pulmonary disease

BackgroundMedicare Part D plans are required to provide Medication therapy management (MTM) services to eligible beneficiaries to optimize medication utilization. Comprehensive medication review (CMR) is a core element of the MTM program. Despite the availability of advanced medical treatment for patients with chronic obstructive pulmonary disease (COPD), medication adherence to maintenance medications poses a continued challenge for patients with COPD. ObjectiveTo examine the effects of CMR on medication adherence among patients with COPD. MethodsMedicare data for 2016–2017 linked to Area Health Resource Files were analyzed. The study population was Medicare beneficiaries with COPD. The intervention group consisted of beneficiaries who received CMR in 2017 but not in 2016. Patients who were eligible for MTM services but did not receive these services in 2016 or 2017 made up the control group. Propensity score matching was used to select an intervention and control group with balanced characteristics. The study outcome was adherence to COPD medications with the proportion of days covered at or above 80%. A difference-in-differences approach was adopted in the logistic regression analyses with an interaction term between the status of CMR receipt and the year 2017. ResultsThe study sample included 25,564 patients with COPD. The proportions of adherent patients were similar in the control group in both years but increased significantly from 60.08% in 2016 to 69.38% in 2017 in the intervention group (P < .001). The odds of medication adherence in the intervention group increased from 2016 to 2017 by 59% more than in the control group (adjusted odds ratio = 1.59, 95% confidence interval = 1.48–1.71). ConclusionsReceiving CMR was associated with improved adherence to COPD medications among Medicare beneficiaries. Policymakers should ensure that Medicare beneficiaries with COPD receive CMR.

Eligibility of sodium-glucose cotransporter-2 inhibitors in heart failure with preserved ejection fraction: Insights from the Colombian heart failure registry (RECOLFACA)

BackgroundThe value of Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitor) therapy in individuals with heart failure with preserved EF (HFpEF) was unknown until the EMPEROR-Preserved trial. We aimed to assess the proportion of patients with HFpEF that are eligible for empagliflozin therapy within the Colombian Heart Failure Registry (RECOLFACA). MethodsRECOLFACA enrolled adult patients with a HF diagnosis during 2017–2019 from 60 medical centers in Colombia. Criteria of the EMPEROR-Preserved Trial were used to recruit participants. The main outcome was individual eligibility with N-terminal pro-B-type natriuretic peptide (NT-proBNP) criteria, while the secondary outcome was eligibility without NT-proBNP data. ResultsRECOLFACA had 799 patients with HFpEF (mean age70.7 ± 13.5; 50.7 % males). According to the major selection criteria of the EMPEROR Preserved Trial, 73.7 % patients would be eligible for empagliflozin therapy initiation when considering the NT-proBNP threshold. The NT-proBNP threshold represented the main determinant of ineligibility in patients with this biomarker measure (13.6 %; n = 16). In patients without NT-proBNP data, the main reasons for exclusion were the diagnosis of symptomatic hypotension or a systolic blood pressure below 100 mmHg (7.5 %), having an eGFR < 20 ml/min/1.73 m2 (4.3 %), and haemoglobin < 9 g/dl (3.1 %). Excluding NT-proBNP criteria increased empagliflozin eligibility to 80.6 %. ConclusionMost patients with HFpEF from RECOLFACA are potential candidates for empagliflozin therapy initiation according to the EMPEROR-Preserved trial criteria. These findings favor the utilization of SGLT-2 inhibitor medications in daily medical practice, which may further decrease morbidity and mortality in HF patients, regardless of their EF classification.