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Paediatric Respiratory Reviews Mar 2024Pulmonary drug delivery is complex due to several challenges including disease-, patient-, and clinicians-related factors. Although many inhaled medications are... (Review)
Review
Pulmonary drug delivery is complex due to several challenges including disease-, patient-, and clinicians-related factors. Although many inhaled medications are available in aerosol medicine, delivering aerosolized medications to patients requires effective disease management. There is a large gap in the knowledge of clinicians who select and provide instructions for the correct use of aerosol devices. Since improper device selection, incorrect inhaler technique, and poor patient adherence to prescribed medications may result in inadequate disease control, individualized aerosol medicine is essential for effective disease management and control. The components of individualized aerosol medicine include: (1) Selecting the right device, (2) Selecting the right interface, (3) Educating the patient effectively, and (4) Increasing patient adherence to therapy. This paper reviews each of these components and provides recommendations to integrate the device and interface into the patient for better clinical outcomes.
Topics: Humans; Aerosols; Nebulizers and Vaporizers; Administration, Inhalation; Patient Compliance; Lung
PubMed: 37739833
DOI: 10.1016/j.prrv.2023.07.003 -
Waste Management (New York, N.Y.) Aug 2023Most households and healthcare facilities usually dispose of contaminated, unused, or expired (CUE) medicines with municipal wastes, the disposal of which usually... (Review)
Review
Most households and healthcare facilities usually dispose of contaminated, unused, or expired (CUE) medicines with municipal wastes, the disposal of which usually amounts to $790/ton in the USA and £450/ton in the UK. Solid (e.g., tablets, capsules, powders) and semi-solid (e.g., ointment, creams) pharmaceuticals are managed with incineration/pyrolysis, encapsulation, and engineered landfills, whereas wastewater treatment plants (WWTPs) are recommended for liquid pharmaceutical wastes (PWs). However, to date, the sustainability and eco-friendliness profile of these techniques are only subjectively ensured, leading to controversial viewpoints in many guidelines. Each technique has relative strengths and weaknesses, and their comparative weighting to maximize these profiles is sought after. The present comprehensive review aims to fulfil knowledge gaps in this regard. Four electronic databases (e.g., PubMed/MEDLINE, Scopus, and ScienceDirect) were searched for PW management (PWM)-related qualitative and quantitative articles published till December 31, 2022. Articles without details of waste disposal techniques and their health and environmental impacts were excluded. Based on the literature review, we determine that incineration can be considered a sustainable option for solid and semi-solid PWs, and WWTPs can be eco-friendly for liquid PWs, whereas encapsulation and landfilling are less sustainable. It is high time that objectively proven sustainable and eco-friendly techniques be implemented for PWM based on their dosage forms or nature of hazards. Medicine take-back, eco-pharmacovigilance, extended producer responsibility, co-payment, and life cycle analysis of pharmaceuticals focusing on reduction, reuse/re-dispensing can be integrated to make existing models sustainable, circular, and eco-friendly.
Topics: Waste Management; Refuse Disposal; Solid Waste; Incineration; Waste Disposal Facilities; Pharmaceutical Preparations
PubMed: 37285639
DOI: 10.1016/j.wasman.2023.05.052 -
Journal of Translational Medicine Oct 2023Despite the improvements in treatment over the last decades, periodontal disease (PD) affects millions of people around the world and the only treatment available is... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Despite the improvements in treatment over the last decades, periodontal disease (PD) affects millions of people around the world and the only treatment available is based on controlling microbial load. Diabetes is known to increase the risk of PD establishment and progression, and recently, glucose metabolism modulation by pharmaceutical or dietarian means has been emphasised as a significant modulator of non-communicable disease development.
METHODS
The impact of pharmaceutically controlling glucose metabolism in non-diabetic animals and humans (REBEC, UTN code: U1111-1276-1942) was investigated by repurposing Metformin, as a mean to manage periodontal disease and its associated systemic risk factors.
RESULTS
We found that glucose metabolism control via use of Metformin aimed at PD management resulted in significant prevention of bone loss during induced periodontal disease and age-related bone loss in vivo. Metformin also influenced the bacterial species present in the oral environment and impacted the metabolic epithelial and stromal responses to bacterial dysbiosis at a single cell level. Systemically, Metformin controlled blood glucose levels and age-related weight gain when used long-term. Translationally, our pilot randomized control trial indicated that systemic Metformin was safe to use in non-diabetic patients and affected the periodontal tissues. During the medication window, patients showed stable levels of systemic blood glucose, lower circulating hsCRP and lower insulin levels after periodontal treatment when compared to placebo. Finally, patients treated with Metformin had improved periodontal parameters when compared to placebo treated patients.
CONCLUSION
This is the first study to demonstrate that systemic interventions using Metformin in non-diabetic individuals aimed at PD prevention have oral-systemic effects constituting a possible novel form of preventive medicine for oral-systemic disease management.
Topics: Animals; Humans; Metformin; Hypoglycemic Agents; Diabetes Mellitus, Type 2; Blood Glucose; Periodontal Diseases; Disease Management
PubMed: 37814261
DOI: 10.1186/s12967-023-04456-1 -
Worldviews on Evidence-based Nursing Oct 2023Having robust power sources and employing effective influence tactics are essential leadership skills for nurse managers in managing human resources, providing quality...
BACKGROUND
Having robust power sources and employing effective influence tactics are essential leadership skills for nurse managers in managing human resources, providing quality care, and managing workplace conflict among nurses.
AIMS
The present study aimed to investigate how bedside nurses perceived their nurse managers' power bases, influence tactics, and conflict management styles. Furthermore, the study investigated the relationship among power bases, influence tactics, and conflict management styles.
METHODS
A descriptive correlational study was conducted at the inpatient care unit of a Saudi hospital. A convenient sample of n = 230 nurses completed the Power Base scale, Influence Behavior Questionnaire (IBQ-R), and Rahim Organizational Conflict Inventory-II (ROCI-II).
RESULTS
Nurses believed their managers were most likely to use referent, legitimate, and expert sources to exercise their power; appreciation and consultation tactics to influence others; and an integrative style to manage conflict. Significant positive correlations were found between the perceived overall power bases and each of the influence behaviors and conflict management styles (r = .466, r = .383, p < .05, respectively). The values of the regression coefficient of power bases significantly contribute to the prediction of 67.8% and 42.2% of the explained variance of influence behaviors and conflict management styles, respectively. In addition, influence behaviors can play a mediating role in this prediction.
LINKING EVIDENCE TO ACTION
Nurse managers should be able to demonstrate the benefit of controlling a wide range of power bases and know how to use influence behaviors and conflict management styles skillfully in each situation to achieve desired goals.
Topics: Humans; Leadership; Workplace; Nurse Administrators; Surveys and Questionnaires; Job Satisfaction
PubMed: 37551965
DOI: 10.1111/wvn.12670 -
Journal of Pharmacy & Pharmaceutical... 2024Microneedle (MN)-assisted drug delivery technology has gained increasing attention over the past two decades. Its advantages of self-management and being minimally... (Review)
Review
Microneedle (MN)-assisted drug delivery technology has gained increasing attention over the past two decades. Its advantages of self-management and being minimally invasive could allow this technology to be an alternative to hypodermic needles. MNs can penetrate the stratum corneum and deliver active ingredients to the body through the dermal tissue in a controlled and sustained release. Long-acting polymeric MNs can reduce administration frequency to improve patient compliance and therapeutic outcomes, especially in the management of chronic diseases. In addition, long-acting MNs could avoid gastrointestinal reactions and reduce side effects, which has potential value for clinical application. In this paper, advances in design strategies and applications of long-acting polymeric MNs are reviewed. We also discuss the challenges in scale manufacture and regulations of polymeric MN systems. These two aspects will accelerate the effective clinical translation of MN products.
Topics: Humans; Skin; Microinjections; Administration, Cutaneous; Pharmaceutical Preparations; Drug Delivery Systems; Polymers
PubMed: 38571937
DOI: 10.3389/jpps.2024.12434 -
Journal of Patient Safety Apr 2024Community-dwelling older adults taking 5 or more medications are at risk for medication-related harm. Managing multiple medications is a challenging task for patients...
OBJECTIVES
Community-dwelling older adults taking 5 or more medications are at risk for medication-related harm. Managing multiple medications is a challenging task for patients and caregivers. Community-dwelling older adults self-manage their medications with minimal healthcare professional supervision. Although organizations, such as the Food and Drug Administration, often issue guidelines to ensure medication safety, how older adults understand and mitigate the risk of harm from medication use in the home environment is poorly understood.
METHODS
We conducted semistructured interviews with community-dwelling older adults 65 years and older who took 5 or more prescription medications to explore medication safety strategies they use. We also compared 2 organizations' medication safety guidelines for areas of concordance and discordance.
RESULTS
A total of 28 older adults were interviewed. Four overarching themes of medication management strategies emerged: collaborating with prescribers, collaborating with pharmacists, learning about medications, and safe practices at home. Study findings revealed that older adults followed some of the published guidelines by the 2 government organizations, although there were some areas of discord. Some of the strategies used were unintentionally against the recommended guidelines. For example, older adults tried weaning themselves off their medications without notifying their providers.
CONCLUSIONS
Older adults and their caregivers in our study used strategies different from those recommended by government organizations in managing medications to enhance drug safety. Patient-provider collaboration and positive patient outcomes can be improved by understanding and respecting strategies older adults use at home. Future studies must effectively incorporate older adults' perspectives when developing medication safety guidelines.
Topics: Humans; Aged; Independent Living; Medication Therapy Management; Pharmaceutical Preparations; Health Personnel; Caregivers
PubMed: 38372504
DOI: 10.1097/PTS.0000000000001200 -
British Journal of Clinical Pharmacology Oct 2023Drug shortages make it difficult or impossible to meet the therapeutic needs of individual patients or populations. In the first part of this review we proposed an... (Review)
Review
Drug shortages make it difficult or impossible to meet the therapeutic needs of individual patients or populations. In the first part of this review we proposed an operational definition that incorporates the processes by which products are manufactured, the causes of shortages and stock-outs (local shortages), and the contributory factors. Here we discuss causes and possible solutions. Drug shortages have complex causes, and a single cause cannot always be identified. Reasons include lack or shortage of raw materials, manufacturing difficulties, regulatory and political actions, voluntary recalls, just-in-time inventory systems, halts in production for financial or other business reasons, low demand (eg, orphan products, reduced usage), mergers, market shifts (eg, diversion to home markets) and unexpected increases in demand (eg, improved diagnosis, new trial information, epidemics and pandemics, inappropriate use, off-label use). Potential solutions are as diverse as the potential causes. Prevention is hard, because shortages are not easily predicted. Everyone in the supply chain is involved in anticipating and managing shortages, with responsibilities for preventing them or at least trying to mitigate their effects. This includes manufacturers and suppliers, particularly of generic formulations, pharmacists, prescribers, patients and governments. Solutions can therefore be linked to the causes and classified according to where the responsibility for implementing them lies.
Topics: Humans; Drug Industry; Drugs, Generic; Commerce; Pharmaceutical Preparations
PubMed: 37455465
DOI: 10.1111/bcp.15853 -
Diabetes & Metabolic Syndrome Apr 2024In this paper, we discuss the existing data on the burden of hypertension in the Philippines and present the status of management, prevention, and control of... (Review)
Review
AIMS
In this paper, we discuss the existing data on the burden of hypertension in the Philippines and present the status of management, prevention, and control of hypertension in the country.
METHODS
A literature review was conducted to synthesize the status of hypertension care in the Philippines.
RESULTS
Hypertension continues to contribute to the country's leading causes of death. Similar to the global trend, almost half of hypertensive Filipinos are still not aware of their condition, and only 27 % have it under control. The prevalence of hypertension has steadily increased from 22 % in 1993 to 25.15 % in 2013. The 2020 Philippine Society for Hypertension clinical practice guideline defines hypertension as an office BP of 140/90 mm Hg or above following the proper standard BP measurement. During the past decade, monotherapy has been the mode of treatment in more than 80 % of Filipino patients. This could also explain why the BP control rates have been low. The most prevalent complications of hypertension in the Philippines were stroke (11.6 %), ischemic heart disease (7.7 %), chronic kidney disease (6.30 %), and hypertensive retinopathy (2.30 %). Hypertension causes economic tolls on patients, from the cost of drugs to hospitalization and complications. Hospitalization from hypertensive complications can easily wipe out the savings of middle-class families and is catastrophic for lower-income Filipinos.
CONCLUSION
In this review, we summarize the existing data on the burden of hypertension among Filipinos and the risk factors associated with the disease. We present the current screening tools, diagnostics, treatment, and prevention strategies for hypertension in the Philippines. Lastly, we propose solutions to meet the global targets of hypertension management and help relieve the growing burden of this disease.
Topics: Humans; Hypertension; Philippines; Disease Management; Antihypertensive Agents; Prevalence; Prognosis
PubMed: 38640838
DOI: 10.1016/j.dsx.2024.103008 -
Clinical Cardiology May 2024The 2023 Multisociety Guideline for the Management of Chronic Coronary Disease (CCD) updates recommendations for CCD, formerly known as "stable ischemic heart disease."... (Review)
Review
BACKGROUND
The 2023 Multisociety Guideline for the Management of Chronic Coronary Disease (CCD) updates recommendations for CCD, formerly known as "stable ischemic heart disease." This condition encompasses a spectrum of coronary vascular pathologies from subclinical to clinical ischemic heart disease.
HYPOTHESIS
The new "ABC" mnemonic offers clinicians a streamlined framework for applying Class One Recommendations (COR1) and integrating recent updates into CCD management.
METHODS
A critical analysis of the 2023 CCD guidelines was conducted, with this review highlighting key elements.
RESULTS
The review outlines crucial changes, including novel recommendations supported by current clinical evidence. The focus is on these developments, clarifying their importance for day-to-day clinical practice.
CONCLUSIONS
The review encourages a synergistic approach between primary healthcare providers and cardiologists to develop comprehensive strategies for lifestyle modification and medication therapy in CCD care. Furthermore, it suggests that utilizing comprehensive risk assessment tools can refine medical decision-making, ultimately enhancing patient care and clinical outcomes.
Topics: Humans; Cardiology; Chronic Disease; Coronary Disease; Disease Management; Practice Guidelines as Topic; Risk Assessment; Societies, Medical; United States
PubMed: 38766996
DOI: 10.1002/clc.24284 -
BMC Medical Informatics and Decision... Nov 2023Patient safety is a central healthcare policy worldwide. Adverse drug events (ADE) are among the main threats to patient safety. Children are at a higher risk of ADE in... (Review)
Review
Identifying the data elements and functionalities of clinical decision support systems to administer medication for neonates and pediatrics: a systematic literature review.
BACKGROUND
Patient safety is a central healthcare policy worldwide. Adverse drug events (ADE) are among the main threats to patient safety. Children are at a higher risk of ADE in each stage of medication management process. ADE rate is high in the administration stage, as the final stage of preventing medication errors in pediatrics and neonates. The most effective way to reduce ADE rate is using medication administration clinical decision support systems (MACDSSs). The present study reviewed the literature on MACDSS for neonates and pediatrics. It identified and classified the data elements that mapped onto the Fast Healthcare Interoperability Resources (FHIR) standard and the functionalities of these systems to guide future research.
METHODS
PubMed/ MEDLINE, Embase, CINAHL, and ProQuest databases were searched from 1995 to June 31, 2021. Studies that addressed developing or applying medication administration software for neonates and pediatrics were included. Two authors reviewed the titles, abstracts, and full texts. The quality of eligible studies was assessed based on the level of evidence. The extracted data elements were mapped onto the FHIR standard.
RESULTS
In the initial search, 4,856 papers were identified. After removing duplicates, 3,761 titles, and abstracts were screened. Finally, 56 full-text papers remained for evaluation. The full-text review of papers led to the retention of 10 papers which met the eligibility criteria. In addition, two papers from the reference lists were included. A total number of 12 papers were included for analysis. Six papers were categorized as high-level evidence. Only three papers evaluated their systems in a real environment. A variety of data elements and functionalities could be observed. Overall, 84 unique data elements were extracted from the included papers. The analysis of reported functionalities showed that 18 functionalities were implemented in these systems.
CONCLUSION
Identifying the data elements and functionalities as a roadmap by developers can significantly improve MACDSS performance. Though many CDSSs have been developed for different medication processes in neonates and pediatrics, few have actually evaluated MACDSSs in reality. Therefore, further research is needed on the application and evaluation of MACDSSs in the real environment.
PROTOCOL REGISTRATION
(dx.doi.org/10.17504/protocols.io.bwbwpape).
Topics: Infant, Newborn; Humans; Child; Decision Support Systems, Clinical; Pharmaceutical Preparations; Medication Errors; Drug-Related Side Effects and Adverse Reactions; Patient Safety
PubMed: 37974195
DOI: 10.1186/s12911-023-02355-5