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Objectives: The present COVID-19 pandemic has impacted all of us, but the pandemic’s impact and repercussions are perceived differently by individuals and governments. Locking down had an impact on pharmaceutical manufacturing, supply, and distribution, causing a medicine shortage. This study aimed to assess drugs used frequently during the pandemic in Iraq their availability and prices and determine how medications are affordable for patients. Study design: This was a pilot study. Methods: This study enrolled 30 pharmacies from rural and urban areas located in Babil governorate, Iraq; from 1 January until 1 March 2021. Results: According to the results, there was a difference between expensive and inexpensive medicines. Medication availability shows that many COVID-19 used medications had no local production like ipratropium, budesonide, Enoxaparin, remdesivir, and others. Levofloxacin vial 500 mg, cost more than 9000 Iraqi dinars, which is more than one day of Iraqi wage (1 day of salary = 8333 Iraqi Dinar; levofloxacin is normally given for seven days, so the total cost will be 583333 Iraqi Dinar for the entire course) that’s rather than other medications and for one family member. Local production prices are high in comparison to imported ones, as in (levofloxacin and Favipiravir). Many medications had increased their prices after the pandemic due to demand, availability and exchange rate. Conclusion: The Iraqi government has to provide medications for the Iraqi people in public hospitals and clinics so that patients do not need to go to private ones. Medications prices have to be controlled uninformed by the government.

In our paper, we encompass the topic of socioeconomic disparities intrinsic to drug pricing and look at ways to ensure that every individual in the United States can access antibiotics equally and equitably. In the United States, a multitude of individuals find themselves struggling with high, out-of-pocket costs for necessary antibiotics or medications.  These issues are generally caused by factors surrounding monopolistic drug markets, high costs for development, and the severity of disease that an individual is facing. We explore these challenges from a plethora of perspectives, such as; the role of specialty pharmacies, limited distribution networks, and the usage of psychotropic medications among youth with Autism Spectrum Disorders (ASD). High prices and restricted access of certain antibiotics for conditions like Hepatitis C highlight the systemic and intrinsic issues within the pharmaceutical industry and how it affects individuals who suffer from this disease or diseases similar to it. On a similar topic to that, ongoing shortages of ADHD medications continue to show the consistent and heavy impact of supply constraints amongst the pharmaceutical industry in the United States. We discuss potential solutions, including but not limited to, accelerating the approval of basic drugs, implementing ceiling prices to prevent high costs, and better integrating health-system specialty pharmacies. By concentrating on the need for policy reforms within the United States and collaboration amongst the various stakeholders that remain involved with drug pricing disparities, this study aims to offer a varied approach in reducing drug pricing disparities and making necessary medications accessible to every individual in the United States, regardless of socioeconomic or health status.

INTRODUCTION: Traumatic brain injury (TBI) is associated with health problems across multiple domains and TBI patients are reported to have high rates of medication use. However, prior evidence is thin due to methodological limitations. Our aim was thus to examine the use of a wide spectrum of medications prescribed to address pain and somatic conditions in a population-based cohort of TBI patients, and to compare this to a sex- and age-matched cohort. We also examined how patient factors such as sex, age, and TBI severity were associated with medication use. METHODS: We assessed Swedish nationwide registers to include all individuals treated for TBI in hospitals or specialist outpatient care between 2006 and 2012. We examined dispensed prescriptions for eight different non-psychotropic medication classes for the 12 months before, and 12 months after, the TBI. We applied a fixed-effects model to compare TBI patients with the matched population cohort. We also stratified TBI patients by sex, age, TBI severity and carried out comparisons using a generalized linear model. RESULTS: We identified 239,425 individuals with an incident TBI and 239,425 matched individuals. TBI patients were more likely to use any medication [Odds ratio (OR) = 2.03, 95% Confidence Interval (CI) = 2.00-2.05], to present with polypharmacy (OR = 1.96, 95% CI = 1.90-2.02), and to use each of the eight medication classes before their TBI, as compared to the matched population cohort. Following the TBI, TBI patients were more likely to use any medication (OR = 1.83, 95% CI = 1.80-1.86), to present with polypharmacy (OR = 1.74, 95% CI = 1.67-1.80), and to use all medication classes, although differences were attenuated. However, differences increased for antibiotics/antivirals (OR = 2.02, 95% CI = 1.99-2.05) and NSAIDs/antirheumatics (OR = 1.62, 95% CI = 1.59-1.65) post-TBI. We also found that females and older patients were more likely to use medications after their TBI than males and younger patie, This study was financed by grants from ALF Medicine (FoUI-961365) and the Swedish Research Council for Health Working Life and Welfare (2015–0028).

Self-medication has emerged as a public health problem worldwide due to the misuse and abuse of medications, representing a high-risk practice, since no medication is free of adverse events. The frequency and amount of self-medication with non-steroidal anti-inflammatory drugs (NSAIDs) and its association with adverse events continue to be a cause for concern in our setting. For this reason, the objective of the present investigation was to carry out a bibliographic review on self-medication with NSAIDs in the population, focusing on studies published in the last 5 years. The methodology used was non-experimental, bibliographic and descriptive, consisting of the compilation and analysis of scientific articles published in the last 5 years in various databases such as PubMed, Web of Science, Scielo and Scopus. Of the articles found, 70.3% indicated that the prevalence of self-medication exceeded 50%, while the remaining 25% showed a prevalence of less than 50%. Among the medications most frequently reported as consumed during self-medication are ibuprofen, diclofenac, aspirin and metamizole. The most common causes for NSAID use were headache, menstrual cramps, and fever. In conclusion, the increasing prevalence of self-medication practices raises concern, which is why it is considered imperative to implement educational activities and awareness programs. These measures seek to stop self-medication in the population, since health education about responsible self-medication can prevent abuse and long-term side effects., La automedicación ha emergido como un problema de salud pública a nivel mundial debido al mal uso y abuso de medicamentos, representando una práctica de alto riesgo, ya que ningún medicamento está exento de eventos adversos. La frecuencia y cantidad de automedicación con antiinflamatorios no esteroides (AINE) y su asociación con eventos adversos continúan siendo motivo de preocupación en nuestro entorno. Por este motivo, el objetivo de la presente investigación fue realizar una revisión bibliográfica sobre la automedicación con AINE en la población, centrándose en estudios publicados en los últimos 5 años. La metodología empleada fue de tipo no experimental, bibliográfica y descriptiva, consistiendo en la recopilación y análisis de artículos científicos publicados en los últimos 5 años en diversas bases de datos como PubMed, Web of Science, Scielo y Scopus. De los artículos encontrados, el 70,3% señaló que la prevalencia de la automedicación superó el 50%, mientras que el 25% restante mostró una prevalencia inferior al 50%. Entre los medicamentos más frecuentemente reportados como consumidos durante la automedicación se encuentran el ibuprofeno, diclofenaco, aspirina y metamizol. Las causas más comunes para el consumo de AINE fueron el dolor de cabeza, cólicos menstruales y fiebre. En conclusión, la creciente prevalencia de prácticas de automedicación genera preocupación, por lo que se considera imperativo implementar actividades educativas y programas de concientización. Estas medidas buscan frenar la automedicación en la población, ya que la educación sanitaria sobre la automedicación responsable puede prevenir el abuso y los efectos secundarios a largo plazo.

Self-medication has emerged as a public health problem worldwide due to the misuse and abuse of medications, representing a high-risk practice, since no medication is free of adverse events. The frequency and amount of self-medication with non-steroidal anti-inflammatory drugs (NSAIDs) and its association with adverse events continue to be a cause for concern in our setting. For this reason, the objective of the present investigation was to carry out a bibliographic review on self-medication with NSAIDs in the population, focusing on studies published in the last 5 years. The methodology used was non-experimental, bibliographic and descriptive, consisting of the compilation and analysis of scientific articles published in the last 5 years in various databases such as PubMed, Web of Science, Scielo and Scopus. Of the articles found, 70.3% indicated that the prevalence of self-medication exceeded 50%, while the remaining 25% showed a prevalence of less than 50%. Among the medications most frequently reported as consumed during self-medication are ibuprofen, diclofenac, aspirin and metamizole. The most common causes for NSAID use were headache, menstrual cramps, and fever. In conclusion, the increasing prevalence of self-medication practices raises concern, which is why it is considered imperative to implement educational activities and awareness programs. These measures seek to stop self-medication in the population, since health education about responsible self-medication can prevent abuse and long-term side effects., La automedicación ha emergido como un problema de salud pública a nivel mundial debido al mal uso y abuso de medicamentos, representando una práctica de alto riesgo, ya que ningún medicamento está exento de eventos adversos. La frecuencia y cantidad de automedicación con antiinflamatorios no esteroides (AINE) y su asociación con eventos adversos continúan siendo motivo de preocupación en nuestro entorno. Por este motivo, el objetivo de la presente investigación fue realizar una revisión bibliográfica sobre la automedicación con AINE en la población, centrándose en estudios publicados en los últimos 5 años. La metodología empleada fue de tipo no experimental, bibliográfica y descriptiva, consistiendo en la recopilación y análisis de artículos científicos publicados en los últimos 5 años en diversas bases de datos como PubMed, Web of Science, Scielo y Scopus. De los artículos encontrados, el 70,3% señaló que la prevalencia de la automedicación superó el 50%, mientras que el 25% restante mostró una prevalencia inferior al 50%. Entre los medicamentos más frecuentemente reportados como consumidos durante la automedicación se encuentran el ibuprofeno, diclofenaco, aspirina y metamizol. Las causas más comunes para el consumo de AINE fueron el dolor de cabeza, cólicos menstruales y fiebre. En conclusión, la creciente prevalencia de prácticas de automedicación genera preocupación, por lo que se considera imperativo implementar actividades educativas y programas de concientización. Estas medidas buscan frenar la automedicación en la población, ya que la educación sanitaria sobre la automedicación responsable puede prevenir el abuso y los efectos secundarios a largo plazo.

BACKGROUND: High out-of-pocket prescription drug costs contribute to financial toxicity, medication nonadherence, and adverse cardiovascular (CV) outcomes. Policymakers recently passed the Inflation Reduction Act, which will cap Medicare out-of-pocket drug costs at $2,000/year and expand full low-income subsidies (LIS). It is unclear how these provisions will affect Medicare beneficiaries with CV risk factors and/or conditions. OBJECTIVES: The authors sought to characterize the population of Medicare beneficiaries with CV risk factors/conditions experiencing out-of-pocket prescription drug costs >$2,000/year and estimate their potential savings under the Inflation Reduction Acts spending cap; identify sociodemographic characteristics associated with out-of-pocket costs >$2,000/year; and characterize beneficiaries newly eligible for LIS under the Inflation Reduction Act. METHODS: This was a cross-sectional study of Medicare beneficiaries aged ≥65 years with ≥1 CV risk factor/condition from 2016 to 2019. RESULTS: An annual estimated 34,056,335 ± 855,653 Medicare beneficiaries (mean ± SE) had ≥1 CV risk factor/condition, of whom 1,020,484 ± 77,055 experienced out-of-pocket drug costs >$2,000/year. The likelihood of experiencing out-of-pocket drug costs >$2,000/year was lower among adults ≥75 years vs 65 to 74 years (adjusted OR: 0.67; 95% CI: 0.49-0.93) and for low-income vs higher-income adults. Among beneficiaries currently spending >$2,000/year, estimated median out-of-pocket drug savings would be $855/year and total annual savings $1,723,031,307 ± $91,150,609 under the Inflation Reduction Act. An estimated 1,289,861 beneficiaries would also become newly eligible for LIS. CONCLUSIONS: More than 1 million older adults with CV risk factors and/or conditions spend >$2,000/year out-of-pocket on prescription drugs and will likely benefit from the Inflation Reduction Acts cap, with estimated total out-of-pocket savings of $1.7 bi

Background: To improve our understanding of adherence to discharge medications in the ED and within research trials, we sought to quantify medication adherence and identify predictors thereof in children with acute gastroenteritis (AGE). Methods: We conducted a secondary analysis of a randomized trial of twice daily probiotic for 5 days. The population included previously healthy children aged 3–47 months with AGE. The primary outcome was patient-reported adherence to the treatment regimen, defined a priori as having received >70% of the prescribed doses. Secondary outcomes included predictors of treatment adherence and concordance between patient-reported adherence and the returned medication sachet counts.Results: After excluding participants with missing data on adherence, 760 participants were included in this analysis: 383 in the probiotic arm (50.4%); and 377 in the placebo arm (49.6%). Self-reported adherence was similar in both groups (77.0% in probiotic versus 80.3% in placebo). There was good agreement between self-reported adherence and sachet counts (87% within limits of agreement (-2.9 to 3.5 sachets) on the Bland-Altman plots). In the multivariable regression model, covariates associated with adherence were greater number of days of diarrhea post-emergency department visit, and the study site; covariates negatively associated with adherence were age 12-23 months, severe dehydration and greater total number of vomiting and diarrhea episodes after enrolment. Conclusions: Longer duration of diarrhea and study site were associated with higher probiotic adherence. Age 12-23 months, severe dehydration and greater number of vomiting and diarrhea episodes post enrolment negatively predicted treatment adherence.

A scientific advisory panel of seven U.S. and Canadian sleep experts performed a clinical appraisal by comparing general medical opinion, assessed via a survey of practicing clinicians, regarding insomnia treatment, with the available scientific evidence. This clinical appraisal focuses on the specific statement, "Treatments for insomnia have uniformly been shown to significantly improve the associated daytime impairment seen with insomnia." The advisory panel reviewed and discussed the available body of evidence within the published medical literature to determine what discrepancies may exist between the currently published evidence base and general medical opinion. The advisory panels' evaluation of this statement was also compared with the results of a national survey of primary care physicians, psychiatrists, nurse practitioners, physician assistants, and sleep specialists in the United States. Contrary to general medical opinion, the expert advisory panel concluded that the medical literature did not support the statement. This gap highlights the need to educate the general medical community regarding insomnia treatment efficacy in pursuit of improved treatment outcomes.

Objective: To design an instrument to measure the adoption of the role of the family caregiver in the administration of medications in people with chronic disease and to establish both its content and facial validity. Method: Methodological study that included three phases: design of the instrument, determination of content validity with 9 experts and determination of facial validity through cognitive interviews with 14 caregivers and judgments of 30 caregivers of adults with chronic diseases. Results: a questionnaire made up of 32 items distributed in 3 dimensions called tasks, organization and response to the role was obtained. The instrument presented adequate content validity since all the items exceeded the minimum CVI of 0.58, while for the total scale it was 0.97. For its part, facial validity showed that clarity was 99.6%, comprehension was 98.4%, and precision was 96.9%. Conclusion: the instrument Adoption of the role in drug administration logically measures the construct and the items that comprise it adequately represent its domains., Objectivo: Conceber um instrumento para medir a adopção do papel do cuidador familiar na administração de medicamentos em pessoas com doenças crónicas e estabelecer tanto o seu conteúdo como a sua validade facial. Método: Estudo metodológico que incluiu três fases: concepção do instrumento, determinação da validade do conteúdo com 9 peritos e determinação da validade facial através de entrevistas cognitivas com 14 cuidadores e julgamentos de 30 cuidadores de adultos doentes crónicos. Resultados: Foi obtido um questionário constituído por 32 itens distribuídos em 3 dimensões chamadas trabalho, organização e resposta ao papel. O instrumento mostrou uma validade de conteúdo adequada, dado que todos os itens excederam o CVI mínimo de 0,58, enquanto que para a escala total foi de 0,97. A validade facial mostrou que a clareza era de 99,6%, a compreensão era de 98,4% e a precisão de 96,9%. Conclusão: O instrumento de Adopção do Papel de Administração de Medicamentos mede logicamente a construção e os seus itens representam adequadamente os seus domínios., Objetivo: Diseñar un instrumento para medir la adopción del rol del cuidador familiar en la administración de medicamentos en personas con enfermedad crónica y establecer tanto su validez de contenido como facial. Método: Estudio metodológico que incluyó tres fases: diseño del instrumento, determinación de la validez de contenido con 9 expertos y determinación de la validez facial mediante entrevistas cognitivas a 14 cuidadores y juicios de 30 cuidadores de adultos con enfermedades crónicas. Resultados: Se obtuvo un cuestionario conformado por 32 ítems distribuidos en 3 dimensiones denominadas labores, organización y respuesta ante el rol. El instrumento presentó una adecuada validez de contenido dado que todos los ítems superaron el CVI mínimo de 0,58, mientras que para la escala total fue de 0,97. Por su parte, la validez facial mostró que la claridad fue del 99,6%, la comprensión fue del 98,4% y la precisión fue del 96,9%. Conclusión: El instrumento Adopción del rol en la administración de medicamentos mide de forma lógica el constructo y los ítems que lo conforman representan adecuadamente sus dominios.

BackgroundHeart failure is a prevailing diagnosis of hospitalization and readmission within 6 months, and nearly a quarter of these patients die within a year. Guideline-directed medication therapies reduce risk of mortality by 73% over 2 years; however, the implementation of these therapies to their target dose in clinical practice continues to be challenging. In 2020, the Veterans Affairs (VA) Health Care System developed a HF dashboard to monitor and improve outpatient HF management. The DASH-HF (Dashboard Activated Services and Telehealth for Heart Failure) study is a randomized, pragmatic clinical trial to evaluate proactive dashboard-directed telehealth clinics to improve the use and dosing of guideline-directed medication therapy for patients with heart failure with reduced ejection fraction not on optimal guideline-directed medication therapy within the VA.MethodsThree hundred veterans with heart failure with reduced ejection fraction met inclusion criteria with an optimization potential score (OPS) of 5 or less out of 10, representing nonoptimal guideline-directed medication therapy. The primary outcome was a composite score of guideline-directed medical therapy, the OPS, 6 months after the end of the intervention. Secondary outcomes included active prescriptions for each individual guideline-directed medical therapy class, HF-related hospitalizations, deaths, and clinician time per patient during the intervention clinics.ResultsThere was no significant difference between the intervention arm and usual care group in the primary outcome (OPS, 2.9; SD=2.1 versus OPS, 2.6, SD=2.1); adjusted mean difference 0.3 (95% CI, -0.1 to 0.7) or in the prespecified secondary outcomes for hospitalization and all-cause mortality for the intervention of proactive dashboard-based clinics.ConclusionsA dashboard-based clinic intervention did not improve the OPS or secondary outcomes of hospitalization and all-cause mortality. There remains a larger opportunity to better target

This thesis focuses on promoting patient safety in older persons using medications. Given that medications can unintentionally harm patients, the World Health Organisation emphasises “Medication without harm” as a global patient safety challenge. Older persons are more likely to experience harm, and harm tends to occur when prescribing or monitoring medications. Co-production of healthcare with patients may reduce the risk of adverse events and can serve as a resource to promote safety in healthcare. Accordingly, this thesis aims to increase knowledge of how older persons and healthcare professionals can co-produce a solution for improved medication evaluation and thereby promote patient safety. Co-design is an approach that emphasises patient involvement in improvements of healthcare services. Therefore, the thesis was guided by the four phases of the Double Diamond framework for co-design. In the Discover phase experiences of medication evaluations were collected. Older persons were interviewed and data were analysed using qualitative inductive content analysis (Paper I). Critical Incident Technique was used to collect and analyse data from interviews with healthcare professionals in primary care (Paper II). In the Define and Develop phases, a case study design was used to explore older persons’, nurses’ and physicians’ design choices for a medication and their experiences of a remote co-design approach. Collected data were analysed using descriptive statistics along with directed content analysis (Paper III) and thematic analysis (Paper IV). In the Deliver phase, the feasibility of applying a medication plan in primary care, as well as the study methods used were examined. Data were analysed using descriptive statistics and inductive content analysis (Paper V). The findings showed that older persons reported having a responsibility to engage in their medication evaluations, even if some felt unable to do so or considered themselves unconcerned. Continuity of care

Définie comme une douleur qui persiste au-delà de trois mois, la douleur chronique (DC) touche environ 20 % de la population générale. Malgré des décennies de recherche sur la DC et son traitement, on constate que sa gestion continue d’être sous-optimale. Davantage d’études sont requises afin de mieux comprendre le contexte réel de l’usage des médicaments pour le traitement de la DC. La polypharmacie (utilisation de ≥5 médicaments) est un phénomène reconnu comme étant la règle plutôt que l’exception pour le traitement de la DC et la polypharmacie excessive (≥10 médicaments) est sa forme sévère et peu étudiée. Les objectifs du présent projet de maîtrise étaient de : 1) mesurer la prévalence de la polypharmacie et de la polypharmacie excessive chez les personnes vivant avec de la DC, 2) identifier les facteurs sociodémographiques et cliniques associés à la polypharmacie excessive dans cette même population. Ce projet a été réalisé grâce aux données de la Cohorte COPE (ChrOnic Pain trEatment), une infrastructure de recherche découlant du recrutement web de 1935 personnes vivant avec de la DC entre mai et octobre 2019 dans les différentes régions du Québec. La présence de polypharmacie et de polypharmacie excessive a été établie sur la base du nombre de médicaments (toutes indications confondues) rapporté par les personnes participantes. Des statistiques descriptives et une régression multivariable ont été appliquées pour répondre aux objectifs de l’étude. Notre projet a montré que la polypharmacie est fréquente chez les personnes qui vivent avec la DC (7 sur 10) et la polypharmacie excessive, une situation encore plus risquée, touche une personne sur quatre. Les facteurs associés à de plus grandes chances de rapporter utiliser ≥10 médicaments étaient le pays de naissance (être né au Canada), l’utilisation de médicaments prescrits, une intensité de la douleur plus élevée (0-10) et un meilleur soulagement de la douleur (0-100 %). Les facteurs associés à de plus faibles c, Chronic pain (CP) is defined as pain that persists or recurs longer than three months and affects approximately 20% of the general population. Despite decades of research on CP and its treatment, there is evidence that its management is suboptimal. More studies are needed to better understand the real-world context of medication use in CP treatment. Polypharmacy, defined as the use of ≥5 medications, is recognized as the rule rather than the exception for treating, and excessive polypharmacy, defined as the use of ≥10 medications, is its severe form far less studied. The objectives of this project were to: (1) Measure the prevalence of polypharmacy and excessive polypharmacy in individuals living with CP and (2) Identify sociodemographic and clinical factors associated with excessive polypharmacy in this same population. This project used data from the COPE (ChrOnic Pain trEatment) Cohort, a research infrastructure derived from the web recruitment of 1935 people living with CP between May and October 2019 in all regions of Quebec. The presence of polypharmacy and excessive polypharmacy was established based on the number of medications reported by the participants for all indications combined. Descriptive statistics and multivariable regression were applied to meet the study objectives. Our project showed that polypharmacy is common among people living with CP, with 7 in 10 individuals affected, and excessive polypharmacy, an even riskier situation, affecting 1 in 4 people. Factors associated with greater chances of reporting excessive polypharmacy (vs. <10 medications) included being born in Canada, using prescribed pain medications, and reporting greater pain intensity (0- 10) or pain relief from currently used pain treatments (0-100%). Factors associated with lower chances of excessive polypharmacy were using physical and psychological pain treatments, reporting better general health/physical functioning, and being employed. This study sheds light on a

This thesis focuses on promoting patient safety in older persons using medications. Given that medications can unintentionally harm patients, the World Health Organisation emphasises “Medication without harm” as a global patient safety challenge. Older persons are more likely to experience harm, and harm tends to occur when prescribing or monitoring medications. Co-production of healthcare with patients may reduce the risk of adverse events and can serve as a resource to promote safety in healthcare. Accordingly, this thesis aims to increase knowledge of how older persons and healthcare professionals can co-produce a solution for improved medication evaluation and thereby promote patient safety. Co-design is an approach that emphasises patient involvement in improvements of healthcare services. Therefore, the thesis was guided by the four phases of the Double Diamond framework for co-design. In the Discover phase experiences of medication evaluations were collected. Older persons were interviewed and data were analysed using qualitative inductive content analysis (Paper I). Critical Incident Technique was used to collect and analyse data from interviews with healthcare professionals in primary care (Paper II). In the Define and Develop phases, a case study design was used to explore older persons’, nurses’ and physicians’ design choices for a medication and their experiences of a remote co-design approach. Collected data were analysed using descriptive statistics along with directed content analysis (Paper III) and thematic analysis (Paper IV). In the Deliver phase, the feasibility of applying a medication plan in primary care, as well as the study methods used were examined. Data were analysed using descriptive statistics and inductive content analysis (Paper V). The findings showed that older persons reported having a responsibility to engage in their medication evaluations, even if some felt unable to do so or considered themselves unconcerned. Continuity of care

BACKGROUND: Harm from medications is a major patient safety challenge among older persons. Adverse drug events tend to arise when prescribing or evaluating medications; therefore, interventions targeting these may promote patient safety. Guidelines highlight the value of a joint plan for continued treatment. If such a plan includes medications, a medication plan promoting patient safety is advised. There is growing evidence for the benefits of including patients and health care professionals in initiatives for improving health care products and services through co-design. OBJECTIVE: This study aimed to identify participants' needs and requirements for a medication plan and explore their reasoning for different design choices. METHODS: Using a case study design, we collected and analyzed qualitative and quantitative data and compared them side by side. We explored the needs and requirements for a medication plan expressed by 14 participants (older persons, nurses, and physicians) during a co-design initiative in a regional health system in Sweden. We performed a directed content analysis of qualitative data gathered from co-design sessions and interviews. Descriptive statistics were used to analyze the quantitative data from survey answers. RESULTS: A medication plan must provide an added everyday value related to safety, effort, and engagement. The physicians addressed challenges in setting aside time to apply a medication plan, whereas the older persons raised the potential for increased patient involvement. According to the participants, a medication plan needs to support communication, continuity, and interaction. The nurses specifically addressed the need for a plan that was easy to gain an overview of. Important function requirements included providing instant access, automation, and attention. Content requirements included providing detailed information about the medication treatment. Having the plan linked to the medication list and instantly obtainable infor

This thesis focuses on promoting patient safety in older persons using medications. Given that medications can unintentionally harm patients, the World Health Organisation emphasises “Medication without harm” as a global patient safety challenge. Older persons are more likely to experience harm, and harm tends to occur when prescribing or monitoring medications. Co-production of healthcare with patients may reduce the risk of adverse events and can serve as a resource to promote safety in healthcare. Accordingly, this thesis aims to increase knowledge of how older persons and healthcare professionals can co-produce a solution for improved medication evaluation and thereby promote patient safety. Co-design is an approach that emphasises patient involvement in improvements of healthcare services. Therefore, the thesis was guided by the four phases of the Double Diamond framework for co-design. In the Discover phase experiences of medication evaluations were collected. Older persons were interviewed and data were analysed using qualitative inductive content analysis (Paper I). Critical Incident Technique was used to collect and analyse data from interviews with healthcare professionals in primary care (Paper II). In the Define and Develop phases, a case study design was used to explore older persons’, nurses’ and physicians’ design choices for a medication and their experiences of a remote co-design approach. Collected data were analysed using descriptive statistics along with directed content analysis (Paper III) and thematic analysis (Paper IV). In the Deliver phase, the feasibility of applying a medication plan in primary care, as well as the study methods used were examined. Data were analysed using descriptive statistics and inductive content analysis (Paper V). The findings showed that older persons reported having a responsibility to engage in their medication evaluations, even if some felt unable to do so or considered themselves unconcerned. Continuity of care

This thesis focuses on promoting patient safety in older persons using medications. Given that medications can unintentionally harm patients, the World Health Organisation emphasises “Medication without harm” as a global patient safety challenge. Older persons are more likely to experience harm, and harm tends to occur when prescribing or monitoring medications. Co-production of healthcare with patients may reduce the risk of adverse events and can serve as a resource to promote safety in healthcare. Accordingly, this thesis aims to increase knowledge of how older persons and healthcare professionals can co-produce a solution for improved medication evaluation and thereby promote patient safety. Co-design is an approach that emphasises patient involvement in improvements of healthcare services. Therefore, the thesis was guided by the four phases of the Double Diamond framework for co-design. In the Discover phase experiences of medication evaluations were collected. Older persons were interviewed and data were analysed using qualitative inductive content analysis (Paper I). Critical Incident Technique was used to collect and analyse data from interviews with healthcare professionals in primary care (Paper II). In the Define and Develop phases, a case study design was used to explore older persons’, nurses’ and physicians’ design choices for a medication and their experiences of a remote co-design approach. Collected data were analysed using descriptive statistics along with directed content analysis (Paper III) and thematic analysis (Paper IV). In the Deliver phase, the feasibility of applying a medication plan in primary care, as well as the study methods used were examined. Data were analysed using descriptive statistics and inductive content analysis (Paper V). The findings showed that older persons reported having a responsibility to engage in their medication evaluations, even if some felt unable to do so or considered themselves unconcerned. Continuity of care

We aimed to identify promising novel medications for child and adolescent mental health problems. We systematically searched https://clinicaltrials.gov/ and https://www.clinicaltrialsregister.eu/ (from 01/01/2010–08/23/2022) for phase 2 or 3 randomized controlled trials (RCTs) of medications without regulatory approval in the US, Europe or Asia, including also RCTs of dietary interventions/probiotics. Additionally, we searched phase 4 RCTs of agents targeting unlicensed indications for children/adolescents with mental health disorders. We retrieved 234 ongoing or completed RCTs, including 26 (11%) with positive findings on ≥ 1 primary outcome, 43 (18%) with negative/unavailable results on every primary outcome, and 165 (70%) without publicly available statistical results. The only two compounds with evidence of significant effects that were replicated in ≥ 1 additional RCT without any negative RCTs were dasotraline for attention-deficit/hyperactivity disorder, and carbetocin for hyperphagia in Prader-Willi syndrome. Among other strategies, targeting specific symptom dimensions in samples stratified based on clinical characteristics or established biomarkers may increase chances of success in future development programmes.

BACKGROUND: Harm from medications is a major patient safety challenge. Most adverse drug events arise when a medication is prescribed or reevaluated. Therefore, interventions in this area may improve patient safety. A medication plan, that is, a plan for continued treatment with medications, may support patient safety. Participation of patients in the design of health care products or services may improve patient safety. Co-design, as in the Double Diamond framework from the Design Council, England, can emphasize patient involvement. As the COVID-19 pandemic brought restrictions to face-to-face co-design approaches, interest in remote approaches increased. However, it is uncertain how best to perform remote co-design. Therefore, we explored a remote approach, which brought together older persons and health care professionals to co-design a medication plan prototype in the electronic health record, aiming to support patient safety. OBJECTIVE: This study aimed to describe how remote co-design was applied to create a medication plan prototype and to explore participants' experiences with this approach. METHODS: Within a case study design, we explored the experiences of a remote co-design initiative with 14 participants in a regional health care system in southern Sweden. Using descriptive statistics, quantitative data from questionnaires and web-based workshop timestamps were analyzed. A thematic analysis of the qualitative data gathered from workshops, interviews, and free-text responses to the survey questions was performed. Qualitative and quantitative data were compared side by side in the discussion. RESULTS: The analysis of the questionnaires revealed that the participants rated the experiences of the co-design initiative very high. In addition, the balance between how much involved persons expressed their wishes and were listened to was considered very good. Marked timestamps from audio recordings showed that the workshops proceeded according to the plan. The th

Coronary artery disease (CAD) management involves a multifaceted approach aimed at reducing risk factors, improving symptoms, and preventing disease progression. Lifestyle modifications form the foundation of CAD management, emphasizing a healthy diet, regular exercise, smoking cessation, weight management, and stress reduction. Adopting these changes can effectively control blood pressure, lipid levels, and overall cardiovascular health. Medical therapies play a vital role in CAD management. Antiplatelet drugs like aspirin reduce the risk of blood clot formation, while lipid-lowering agents, particularly statins, help lower cholesterol levels and slow atherosclerosis development. Beta-blockers and ACE inhibitors/ARBs are commonly prescribed to control heart rate, blood pressure, and improve heart function. In cases of severe CAD, interventional procedures may be necessary. Percutaneous coronary intervention (PCI) involves inserting a stent into the narrowed artery to restore blood flow, while coronary artery bypass grafting (CABG) creates new pathways to bypass blocked arteries. Secondary prevention is essential for patients with a history of CAD. Regular follow-ups, adherence to prescribed medications, and participation in cardiac rehabilitation programs can significantly reduce the risk of future cardiac events. Efforts to manage CAD extend beyond the individual level. Public health initiatives and community awareness campaigns promote healthy lifestyle choices to prevent CAD on a broader scale. In conclusion, the management of coronary artery disease demands a comprehensive approach, incorporating lifestyle changes, medical therapies, interventional procedures, and secondary prevention strategies. By addressing CAD from multiple angles, healthcare professionals can effectively reduce its impact, improve patient outcomes, and enhance the overall cardiovascular health of affected individuals. Keywords: Heart, Coronary artery, Lifestyle, medications.

Coronary artery disease (CAD) management involves a multifaceted approach aimed at reducing risk factors, improving symptoms, and preventing disease progression. Lifestyle modifications form the foundation of CAD management, emphasizing a healthy diet, regular exercise, smoking cessation, weight management, and stress reduction. Adopting these changes can effectively control blood pressure, lipid levels, and overall cardiovascular health. Medical therapies play a vital role in CAD management. Antiplatelet drugs like aspirin reduce the risk of blood clot formation, while lipid-lowering agents, particularly statins, help lower cholesterol levels and slow atherosclerosis development. Beta-blockers and ACE inhibitors/ARBs are commonly prescribed to control heart rate, blood pressure, and improve heart function. In cases of severe CAD, interventional procedures may be necessary. Percutaneous coronary intervention (PCI) involves inserting a stent into the narrowed artery to restore blood flow, while coronary artery bypass grafting (CABG) creates new pathways to bypass blocked arteries. Secondary prevention is essential for patients with a history of CAD. Regular follow-ups, adherence to prescribed medications, and participation in cardiac rehabilitation programs can significantly reduce the risk of future cardiac events. Efforts to manage CAD extend beyond the individual level. Public health initiatives and community awareness campaigns promote healthy lifestyle choices to prevent CAD on a broader scale. In conclusion, the management of coronary artery disease demands a comprehensive approach, incorporating lifestyle changes, medical therapies, interventional procedures, and secondary prevention strategies. By addressing CAD from multiple angles, healthcare professionals can effectively reduce its impact, improve patient outcomes, and enhance the overall cardiovascular health of affected individuals. Keywords: Heart, Coronary artery, Lifestyle, medications.

We aimed to identify promising novel medications for child and adolescent mental health problems. We systematically searched https://clinicaltrials.gov/ and https://www.clinicaltrialsregister.eu/ (from 01/01/2010–08/23/2022) for phase 2 or 3 randomized controlled trials (RCTs) of medications without regulatory approval in the US, Europe or Asia, including also RCTs of dietary interventions/probiotics. Additionally, we searched phase 4 RCTs of agents targeting unlicensed indications for children/adolescents with mental health disorders. We retrieved 234 ongoing or completed RCTs, including 26 (11%) with positive findings on ≥ 1 primary outcome, 43 (18%) with negative/unavailable results on every primary outcome, and 165 (70%) without publicly available statistical results. The only two compounds with evidence of significant effects that were replicated in ≥ 1 additional RCT without any negative RCTs were dasotraline for attention-deficit/hyperactivity disorder, and carbetocin for hyperphagia in Prader-Willi syndrome. Among other strategies, targeting specific symptom dimensions in samples stratified based on clinical characteristics or established biomarkers may increase chances of success in future development programmes.

Abstract Introduction This study examined whether smokers’ harm perceptions of nicotine replacement therapy (NRT) and nicotine vaping products (NVPs) relative to cigarettes predicted their subsequent use as smoking cessation aids during their last quit attempt (LQA). Aims and Methods We analyzed data from 1,315 current daily smokers (10+ cigarettes per day) who were recruited at Wave 1 (2016), and who reported making a quit attempt by Wave 2 (2018) of the International Tobacco Control Four Country Smoking and Vaping Surveys in Australia, Canada, England, and the United States. We used multinomial logistic regression models to examine prospective associations between harm perceptions of (a) NRT and (b) NVPs and their use at LQA, controlling for socio-demographic and other potential confounders. Results Smokers who perceive that (a) NRT and (b) NVPs are much less harmful than cigarettes were more likely to subsequently use the respective product as an aid than using no aid or other aids during LQA (adjusted relative risk ratio [aRRR] = 3.79, 95%CI = 2.16–6.66; and aRRR = 2.11, 95%CI = 1.29–3.45, respectively) compared to smokers who perceive these products as equally or more harmful. Additionally, those who perceive NVPs as much less harmful than cigarettes were less likely to use NRT as a quit aid (aRRR = 0.34, 95%CI = 0.20–0.60). No country variations for these associations were found. Conclusions This study found that smokers’ perceptions of the harmfulness of (a) NRT and (b) NVPs relative to cigarettes predicted the respective product use when trying to quit smoking. Corrective education targeting misperceptions of nicotine products’ relative harmfulness may facilitate

While behavioral interventions remain the mainstay of treatment of autism spectrum disorder (ASD), several potential targeted treatments addressing the underlying neurophysiology of ASD have emerged in the last few years. These are promising for the potential to, in future, become part of the mainstay treatment in addressing the core symptoms of ASD. Although it is likely that the development of future targeted treatments will be influenced by the underlying heterogeneity in etiology, associated genetic mechanisms influencing ASD are likely to be the first targets of treatments and even gene therapy in the future for ASD. In this article, we provide a review of current psychopharmacological treatment in ASD including those used to address common comorbidities of the condition and upcoming new targeted approaches in autism management. Medications including metformin, arbaclofen, cannabidiol, oxytocin, bumetanide, lovastatin, trofinetide, and dietary supplements including sulforophane and N-acetylcysteine are discussed. Commonly used medications to address the comorbidities associated with ASD including atypical antipsychotics, serotoninergic agents, alpha-2 agonists, and stimulant medications are also reviewed. Targeted treatments in Fragile X syndrome (FXS), the most common genetic disorder leading to ASD, provide a model for new treatments that may be helpful for other forms of ASD.

While behavioral interventions remain the mainstay of treatment of autism spectrum disorder (ASD), several potential targeted treatments addressing the underlying neurophysiology of ASD have emerged in the last few years. These are promising for the potential to, in future, become part of the mainstay treatment in addressing the core symptoms of ASD. Although it is likely that the development of future targeted treatments will be influenced by the underlying heterogeneity in etiology, associated genetic mechanisms influencing ASD are likely to be the first targets of treatments and even gene therapy in the future for ASD. In this article, we provide a review of current psychopharmacological treatment in ASD including those used to address common comorbidities of the condition and upcoming new targeted approaches in autism management. Medications including metformin, arbaclofen, cannabidiol, oxytocin, bumetanide, lovastatin, trofinetide, and dietary supplements including sulforophane and N-acetylcysteine are discussed. Commonly used medications to address the comorbidities associated with ASD including atypical antipsychotics, serotoninergic agents, alpha-2 agonists, and stimulant medications are also reviewed. Targeted treatments in Fragile X syndrome (FXS), the most common genetic disorder leading to ASD, provide a model for new treatments that may be helpful for other forms of ASD.

BackgroundPeople with dementia (PWD) take medications that may be unnecessary or harmful. This problem can be addressed through deprescribing, but it is unclear if PWD would be willing to engage in deprescribing with their providers. Our goal was to investigate attitudes toward deprescribing among PWD.MethodsThis was a cross-sectional study of 422 PWD aged ≥65 years who completed the medications attitudes module of the National Health and Aging Trends Study (NHATS) in 2016. Proxies provided responses when a participant was unable to respond due to health or cognitive problems. Attitudinal outcomes comprised responses to two statements from the patients' attitudes toward deprescribing questionnaire and its revised version (representing belief about the necessity of one's medications and willingness to deprescribe); another elicited the maximum number of pills that a respondent would be comfortable taking.ResultsThe weighted sample represented over 1.8 million PWD; 39% were 75 to 84 years old and 38% were 85 years or older, 60% were female, and 55% reported six or more regular medications. Proxies provided responses for 26% of PWD. Overall, 22% believed that they may be taking one or more medicines that they no longer needed, 87% were willing to stop one or more of their medications, and 50% were uncomfortable taking five or more medications. Attitudinal outcomes were similar across sociodemographic and clinical factors. PWD taking ≥6 medications were more likely to endorse a belief that at least one medication was no longer necessary compared to those taking <6 (adjusted probability 29% [95% confidence interval (CI), 22%-38%] vs. 13% [95% CI, 8%-20%]; p = 0.004); the same applied for willingness to deprescribe (92% [95% CI, 87%-95%] vs. 83% [95% CI, 76%-89%]; p = 0.04).ConclusionsA majority of PWD are willing to deprescribe, representing an opportunity to improve quality of life for this vulnerable population.

Background: Understanding medication use patterns for patients with COVID-19 will provide needed insight into the evolution of COVID-19 treatment over the course of the SARS-CoV-2 pandemic and aid clinical management considerations. Objectives: To systematically determine most frequently used medications among COVID-19 patients overall and by hospitalization status. Secondary objective was use measurement of medications considered potential therapeutic options. Methods: Retrospective cohort study was performed using data from the University of California COVID Research Data Set (UC CORDS) patients between March 10, 2020, and December 31, 2020. Main outcomes were percentages of patients prescribed medications, overall, by age group, and by comorbidity based on hospitalization status for COVID-19 patients. Use percentage by month of COVID-19 diagnosis was measured. Cumulative count of potential therapeutic options was measured over time. Results: Dataset included 22 896 unique patients with COVID-19 (mean [SD] age, 42.4 [20.4] years; 12 154 [53%] women). Most frequently used medications in patients overall were acetaminophen (21.2%), albuterol (14.9%), ondansetron (13.9%), and enoxaparin (10.8%). Dexamethasone use increased from fewer than 50 total hospitalized patients through April who had received the medication, to more than 500 patients by mid-August. Cumulative count of enoxaparin users was the largest throughout the study period. Conclusion and Relevance: In this retrospective cohort study, across age and comorbidity groups, predominant utilization was for supportive care therapy. Dexamethasone and remdesivir experienced large increases in use. Conversely, hydroxychloroquine and azithromycin use markedly dropped. Medication utilization rapidly shifted toward more evidence-concordant treatment of patients with COVID-19 as rigorous study findings emerged.

Gastroesophageal reflux disease (GERD) is a common disease affecting a significant number of adults both globally and in the USA. GERD is clinically diagnosed based on patient-reported symptoms, and the gold standard for diagnosis is ambulatory reflux monitoring, a tool particularly utilized in the common scenario of non-response to therapy or atypical features. Over the past 20 years, there has been a shift toward extending the duration of reflux monitoring, initially from 24 to 48 h and more recently to 96 h, primarily based on a demonstrated increase in diagnostic yield. Further, multiple studies demonstrate clinically relevant variability in day-to-day acid exposure levels in nearly 30% of ambulatory reflux monitoring studies. For these reasons, an ongoing clinical dilemma relates to the optimal activities patients should engage in during prolonged reflux monitoring. Thus, the aims of this review are to detail what is known about variability in daily acid exposure, discuss factors that are known to influence this day-to-day variability (i.e., sleep patterns, dietary/eating habits, stress, exercise, and medications), and finally provide suggestions for patient education and general GERD management to reduce variation in esophageal acid exposure levels.

Aims: Primary care plays an integral role in the management of type 2 diabetes (T2D). We investigated in a large group of individuals in this setting the biochemical profiles, pharmacological management and clinical outcomes as well as their changes over time. Methods: This is a register-based study including relevant laboratory test results requested between 2000 and 2015 by general practitioners in the greater Copenhagen area. We identified 72,044 individuals with T2D on whom data concerning prescription medicine and clinical outcomes were obtained from national registries. Results: The number of individuals with T2D greatly increased from 2001 to 2015. Hemoglobin A1c, estimated glomerular filtration rate and urine albumin creatinine ratio did not change, but cholestrol levels improved. The proportion redeeming anti-diabetics remained around 80%, with an increase for metformin. The use of cardiovascular drugs increased. All-cause and especially cardiovascular mortality decreased over the period. Hospital admissions for non-fatal cardiovascular events dropped. Conclusion: The number of individuals with T2D in primary care increased dramatically whereas pharmacological management, control of risk factors and clinical outcomes seem to have improved. Nevertheless, a conspicuous minority did not receive diabetes-related medication.

Medication waste is a concern for today's society, from both environmental and public health perspectives. This study aims to contribute to the issue by presenting a mixed-methods approach to the problem through reverse logistics. First, a systematic literature review was performed to map the literature and identify the best practices implemented worldwide. The review also provided information for the second part of the study: a proposal for the improvement of Brazil's medications reverse logistics system, viewed from an information management perspective. The method proposed introduces a mechanism for estimating the quantity of unused medications that should be returned to the system. Three groups of stakeholders evaluated the proposal by answering a semi-structured questionnaire. The research also adopted Institutional Theory to draw its conclusions. The literature review revealed a concentration of studies in the United States, a country which has a major concern for public health. Brazil was the second most studied country in the literature: the majority of its studies relating to environmental aspects. Both countries, however, particularly recognize the need to improve the ways unused medication is collected from consumers and returned to the reverse logistics system, and see their respective governments as the main actors promoting this process. The measurement system proposed in this study supports the development of better reverse logistics systems for countries that use information systems to manage medication supply chains. Some resistance to the implementation of the improving method was observed in drugstores due to the costs involved; these costs should be shared with other stakeholders in the pharmaceutical sector.

Aims This qualitative study aims to explore beliefs, attitudes and experiences of injectable glucagon-like-peptide-1 receptor agonists (GLP-1RAs) use and discontinuation, as well as attitudes to further injectable treatment intensification, among adults with type 2 diabetes (T2D). Methods Nineteen in-depth semi-structured interviews lasting (mean +/- standard deviation) 45 +/- 18 min were conducted, face-to-face (n = 14) or via telephone (n = 5). Transcripts were analysed using inductive template analyses. Eligible participants were English-speaking adults with T2D who had recently initiated (

Aims This qualitative study aims to explore beliefs, attitudes and experiences of injectable glucagon-like-peptide-1 receptor agonists (GLP-1RAs) use and discontinuation, as well as attitudes to further injectable treatment intensification, among adults with type 2 diabetes (T2D). Methods Nineteen in-depth semi-structured interviews lasting (mean +/- standard deviation) 45 +/- 18 min were conducted, face-to-face (n = 14) or via telephone (n = 5). Transcripts were analysed using inductive template analyses. Eligible participants were English-speaking adults with T2D who had recently initiated (

Introduction: Emergency departments (ED) use many medications with a range of therapeutic efficacy and potential significant side effects, and many medications have dosage adjustment recommendations based on the patient’s specific genotype. How frequently medications with such pharmaco-genetic recommendations are used in United States (US) EDs has not been studied.  Methods: We conducted a cross-sectional analysis of the 2010–2015 National Hospital Ambulatory Medical Care Survey (NHAMCS). We reported the proportion of ED visits in which at least one medication with Clinical Pharmacogenetics Implementation Consortium (CPIC) recommendation of Level A or B evidence was ordered. Secondary comparisons included distributions and 95% confidence intervals of age, gender, race/ethnicity, ED disposition, geographical region, immediacy, and insurance status between all ED visits and those involving a CPIC medication. Results: From 165,155 entries representing 805,726,000 US ED visits in the 2010–2015 NHAMCS, 148,243,000 ED visits (18.4%) led to orders of CPIC medications. The most common CPIC medication was tramadol (6.3%). Visits involving CPIC medications had higher proportions of patients who were female, had private insurance and self-pay, and were discharged from the ED. They also involved lower proportions of patients with Medicare and Medicaid.  Conclusion: Almost one fifth of US ED visits involve a medication with a pharmacogenetic recommendation that may impact the efficacy and toxicity for individual patients. While direct application of genotyping is still in development, it is important for emergency care providers to understand and support this technology given its potential to improve individualized, patient- centered care.&nbsp

Background: Completing prior authorizations (PAs) can be a lengthy process, which can delay access to appropriate care. A 2017 American Academy of Dermatology survey highlighted that PAs are common across many dermatologic medication classes. However, little is known regarding the impact of PAs on patient care and resource use. Methods: To better characterize the burden of PAs on dermatology practices and their effects on patient care, a survey was conducted in February 2020 among U.S.-based dermatologists (N=3,000) and the Association of Dermatology Administrators/Managers (ADAM) members (N=718). Results: Respondents reported 24% of patients require PAs. Dermatologists and staff spend a mean of 3.3 hours/day on PAs. Sixty percent of dermatologists reported interrupting patient visits for PAs. Sixty-five percent respondents reported PAs were required for clobetasol, 76% for tretinoin, and 42% for 5-fluorouracil. Respondents noted 45% of PA determinations took beyond one week and 17% took beyond two weeks. Respondents reported 12% of PAs resulted in delaying or abandoning treatment and 17% resulted in less appropriate treatment. Conclusions: Prior authorization burden remains high and consumes substantial clinical resources, which may negatively impact patient care. Additionally, they result in prolonged treatment delays and are associated with delaying treatment, abandoning treatment, or using lesser treatment.

Introduction: Emergency departments (ED) use many medications with a range of therapeutic efficacy and potential significant side effects, and many medications have dosage adjustment recommendations based on the patient’s specific genotype. How frequently medications with such pharmaco-genetic recommendations are used in United States (US) EDs has not been studied.  Methods: We conducted a cross-sectional analysis of the 2010–2015 National Hospital Ambulatory Medical Care Survey (NHAMCS). We reported the proportion of ED visits in which at least one medication with Clinical Pharmacogenetics Implementation Consortium (CPIC) recommendation of Level A or B evidence was ordered. Secondary comparisons included distributions and 95% confidence intervals of age, gender, race/ethnicity, ED disposition, geographical region, immediacy, and insurance status between all ED visits and those involving a CPIC medication. Results: From 165,155 entries representing 805,726,000 US ED visits in the 2010–2015 NHAMCS, 148,243,000 ED visits (18.4%) led to orders of CPIC medications. The most common CPIC medication was tramadol (6.3%). Visits involving CPIC medications had higher proportions of patients who were female, had private insurance and self-pay, and were discharged from the ED. They also involved lower proportions of patients with Medicare and Medicaid.  Conclusion: Almost one fifth of US ED visits involve a medication with a pharmacogenetic recommendation that may impact the efficacy and toxicity for individual patients. While direct application of genotyping is still in development, it is important for emergency care providers to understand and support this technology given its potential to improve individualized, patient- centered care.&nbsp

Aim: to analyze the regulation of the sale of medicines by telematic procedures in Spain, as well as the risks and advantages that it presents. Methodology: the legislation on the regulation of the sale of medicines for human use through the Internet in the Spanish legal system was analysed and interpreted. Results: said regulation is found in Royal Decree 870/2013, of November 8, which regulates the distance sale to the public, through websites, of medicines for human use not subject to medical prescription. This Royal Decree limits the sale of medicines through the Internet to those that do not require a medical prescription, since medicines can be sold illegally on the Internet, which poses a threat to public health. However, there are also advantages of this activity, such as the guarantee of access to medicines by the population. This contribution analyses the case of the new dispensing conditions established during the pandemic caused by the new SARS-CoV-2 coronavirus. Conclusions: to guarantee the safety of patients, the sale of medicines online is limited, however, in special situations, such as the health crisis generated by the new coronavirus, the regulatory framework was expanded to guarantee the population's access to medicines., Objetivo: analizar la regulación de la venta de medicamentos por procedimientos telemáticos en España, así como los riesgos y ventajas que esta presenta. Metodología: se analizó e interpretó la legislación en materia de regulación de venta de medicamentos de uso humano a través de Internet en el ordenamiento jurídico español. Resultados: dicha regulación se encuentra en el Real Decreto 870/2013, de 8 de noviembre, por el que se regula la venta a distancia al público, a través de sitios web, de medicamentos de uso humano no sujetos a prescripción médica. Este Real Decreto limita la venta de medicamentos a través de Internet a aquellos que no requieran prescripción médica, ya que en Internet se pueden vender medicamentos ilegalmente, lo cual supone una amenaza para la salud pública. No obstante, también existen ventajas de dicha actividad como es la garantía de acceso a los medicamentos por parte de la población. En la presente contribución se analiza el caso de las nuevas condiciones de dispensación establecidas durante la pandemia provocada por el nuevo coronavirus SARS-CoV-2. Conclusiones: para garantizar la seguridad de los pacientes se limita la venta de medicamentos vía online, no obstante, en situaciones especiales, como la crisis sanitaria generada por el nuevo coronavirus se amplió el marco normativo para garantizar el acceso de la población a los medicamentos., Objetivo: analisar a regulamentação da comercialização de medicamentos por procedimentos telemáticos em Espanha, bem como os riscos e vantagens que apresenta. Metodologia: a legislação foi analisada e interpretada sobre a regulamentação da comercialização de medicamentos de uso humano pela Internet no ordenamento jurídico espanhol. Resultados: o referido regulamento consta do Real Decreto 870/2013, de 8 de novembro, que regulamenta a venda à distância ao público, através de websites, de medicamentos para uso humano não sujeitos a receita médica. Este Decreto Real limita a venda de medicamentos pela Internet aos que não necessitem de receita médica, uma vez que os medicamentos podem ser comercializados ilegalmente na Internet, o que representa uma ameaça para a saúde pública. Porém, também há vantagens dessa atividade, como a garantia de acesso a medicamentos por parte da população. Esta contribuição analisa o caso das novas condições de dispensação estabelecidas durante a pandemia causada pelo novo coronavírus SARS-CoV-2. Conclusões: para garantir a segurança dos pacientes, a venda de medicamentos online é limitada, porém, em situações especiais, como a crise de saúde gerada pelo novo coronavírus, o marco regulatório foi ampliado para garantir o acesso da população aos medicamentos.

Objectives: Older patients with cancer often present with multimorbidity and polypharmacy, but there is little information on the challenges these conditions raise.We aimed to describe health professionals' practice, perceptions and needs related to polypharmacy for older adults receiving cancer treatment. Materials and Methods: We performed a mixed-design exploratory study. Phase 1 involved an online survey of 16 Likert-scale or multiple choices questions regarding polypharmacy and medication management for older patients with cancer. Phase 2 comprised two focus groups with oncology health professionals to learn about their perceptions and needs regarding medication management during cancer treatments. Results: A total of 54 health professionals responded to the survey (nurses = 25; pharmacists = 21; physicians = 6; other = 2). Half of them always or often felt that medication is a significant burden for patients but only a quarter always or often addressed the possibility of stopping medications. Ten health professionals participated in the focus groups. The normalization of the quantity of medications used in relation with aging, as well as the lack of older adults' knowledge about their medication were reported. Other barriers to deprescribing included lack of time and expertise, and issues with communication between health professionals. Conclusion: Although polypharmacy is a concern for many health professionals, most do not discuss deprescribing with older patients with cancer. Normalization of medication use, both by older adults and health professionals, stands as a significant barrier to critical medication review. The development of clinical tools could facilitate identification of circumstances where deprescribing is appropriate and help reduce associated barriers.

This thesis addressed the rapidly growing older adult population and the predicted rise in admissions to hospital and intensive care units (ICUs). Increasing age, frailty and comorbidities in older people are associated with decreasing biological reserve and increasing vulnerability to external stressors. These factors predispose older people to acute issues such as falls and infections, which may contribute to hospital and ICU admissions. These factors also influence patient outcomes, including hospital-acquired complications, stay length and mortality. Interest is growing in post-hospital, longer- term outcomes such as quality of life and death. This study assessed frailty in ICU by a systematic review of the literature. Four reviewers critically screened 2,236 articles and 61 articles were selected. Frailty was mainly identified using the clinical frailty scale (CFS) or a proxy-based version of the Fried frailty phenotype; both had good predictive validity, although the cut-off point for frailty was contentious. Increased frailty, as measured by CFS has been associated with poor health outcomes and increased mortality. A retrospective study explored longer-term trends (over 15 years) in admission rates to ICU, documenting demographics, comorbidities, admission diagnoses and outcomes. This study highlighted that comorbidities occurred in all age groups, particularly amongst older people. High rates of invasive intensive care therapy were associated with all age groups, and a decreased survival rate was associated with the older population. A prospective study evaluated the information from the retrospective study, following 350 critically ill patients over three months. This study included baseline measures of frailty, comorbidities, pre-admission medication,severity illness scores and length of stay. It also examined in-hospital and ICU mortality, the association of frailty with pre-admission medications, comorbidities in critically ill adult patients and follow

Abstract Introduction This study retrospectively describes smoking cessation aids, cessation services, and other types of assistance used by current and ex-smokers at their last quit attempt in four high-income countries. Aims and Methods Data are from the Wave 3 (2020) International Tobacco Control Four Country Smoking and Vaping Survey in Australia, Canada, England, and the United States (US). Eligible respondents were daily smokers or past-daily recent ex-smokers who made a quit attempt/quit smoking in the last 24-months, resulting in 3614 respondents. Self-reported quit aids/assistance included: nicotine vaping products (NVPs), nicotine replacement therapy (NRT), other pharmacological therapies (OPT: varenicline/bupropion/cytisine), tobacco (noncombustible: heated tobacco product/smokeless tobacco), cessation services (quitline/counseling/doctor), other cessation support (e.g., mobile apps/website/pamphlets, etc.), or no aid. Results Among all respondents, at last quit attempt, 28.8% used NRT, 28.0% used an NVP, 12.0% used OPT, 7.8% used a cessation service, 1.7% used a tobacco product, 16.5% other cessation support, and 38.6% used no aid/assistance. Slightly more than half of all smokers and ex-smokers (57.2%) reported using any type of pharmacotherapy (NRT or OPT) and/or an NVP, half-used NRT and/or an NVP (49.9%), and 38.4% used any type of pharmacotherapy (NRT and/or OPT). A quarter of smokers/ex-smokers used a combination of aids. NVPs and NRT were the most prevalent types of cessation aids used in all four countries; however, NRT was more commonly used in Australia relative to NVPs, and in England, NVPs were more commonly used than NRT. The use of NVPs or NRT was more evenly distributed in Canada and the US. Conclusio

Patient safety and quality of care are fundamental pillars in the health policies of various governments and international organizations. The purpose of this study is to evaluate nurses’ perceptions on the degree of implementation of a protocol for the standardization of care and to measure its influence on notification of adverse events related to the administration of medications. This comparative study used data obtained from questionnaires completed by 180 nurses from medical and surgical units. Our analyses included analysis of variance and regression models. We observe that the responses changed unevenly over time in each group, finding significant differences in all comparisons. The mean response rating was increased at 6 months in the intervention group, and this level was maintained at 12 months. With the new protocol, a total of 246 adverse events and 481 incidents without harm was reported. Thus, actions such as the use of protocols and event notification systems should be implemented to improve quality of care and patient safety.

Rheumatoid Arthritis (RA) is one of the most frequent and important types of arthritis, as it is a chronic and aggressive disease that causes joint damage, pain and disability. There is no cure, however there are several lines of treatment aimed at symptoms and preventing joint damage and disability. According to the World Health Organization (WHO), RA is one of the leading causes of absenteeism and premature retirement in the world. It affects between 1 and 1.5% of the world population. The main purpose of this review is to capture the generalities of the biological drugs used in the treatment of RA, what they are, how they are used, types, adverse effects and recommendations to avoid said effects or treat them. The research model is a bibliographic documentary type review. The review shows that biological drugs are used as a second line of action, in the treatment of patients with RA refractory to synthetic disease-modifying antirheumatic drugs (DMARDs). There are several types of these drugs that vary from one country to another, as well as the legislation that regulates them and their costs. Likewise, its effectiveness is associated with other DMARDs, especially when administered with methotrexate. The combination of DMARDs presents better results than its single administration. These biologics effectively improve clinical, functional, and radiographic outcomes, and delay radiographic progression in most cases. Lastly, it is essential to monitor these patients during DMARD treatment since the presence of some side effects is possible., La Artritis Reumatoide (AR) es uno de los tipos de Artritis más frecuentes e importantes, por cuanto se trata de una enfermedad crónica y agresiva que ocasiona daño en las articulaciones, dolor e incapacidad. No tiene cura, sin embargo, existen varias líneas de tratamientos dirigidas a los síntomas y a prevenir el daño en las articulaciones y la incapacidad. De acuerdo con la Organización Mundial de la Salud (OMS), la AR es una de las mayores causas de ausentismo y retiro laboral prematuro en el mundo. Afecta entre el 1 y 1.5 % de la población mundial. El propósito fundamental de la presente revisión es plasmar las generalidades de los fármacos biológicos usados en el tratamiento de la AR, qué son, cómo se usan, tipos, efectos adversos y recomendaciones para evitar dichos efectos o tratarlos. El modelo de investigación es una revisión de tipo documental bibliográfico. De la revisión se desprende que los fármacos biológicos se usan como segunda línea de acción, en el tratamiento de pacientes con AR refractaria a los fármacos antirreumáticos modificadores de la enfermedad (FAME) sintéticos. Existen diversos tipos de estos medicamentos que varían de un país a otro, al igual que la legislación que los regula y sus costos. Asimismo, su efectividad se encuentra asociada a otros FAME, especialmente cuando se administra acompañado con metotrexato. La combinación entre FAME presenta mejores resultados que su administración única. Estos fármacos biológicos mejoran eficazmente los resultados clínicos, funcionales y radiográficos, y retrasan la progresión radiográfica en la mayoría de los casos. Por último, resulta fundamental el monitoreo de estos pacientes durante el tratamiento con FAME ya que es posible la presencia de algunos efectos secundarios.

Rheumatoid Arthritis (RA) is one of the most frequent and important types of arthritis, as it is a chronic and aggressive disease that causes joint damage, pain and disability. There is no cure, however there are several lines of treatment aimed at symptoms and preventing joint damage and disability. According to the World Health Organization (WHO), RA is one of the leading causes of absenteeism and premature retirement in the world. It affects between 1 and 1.5% of the world population. The main purpose of this review is to capture the generalities of the biological drugs used in the treatment of RA, what they are, how they are used, types, adverse effects and recommendations to avoid said effects or treat them. The research model is a bibliographic documentary type review. The review shows that biological drugs are used as a second line of action, in the treatment of patients with RA refractory to synthetic disease-modifying antirheumatic drugs (DMARDs). There are several types of these drugs that vary from one country to another, as well as the legislation that regulates them and their costs. Likewise, its effectiveness is associated with other DMARDs, especially when administered with methotrexate. The combination of DMARDs presents better results than its single administration. These biologics effectively improve clinical, functional, and radiographic outcomes, and delay radiographic progression in most cases. Lastly, it is essential to monitor these patients during DMARD treatment since the presence of some side effects is possible., La Artritis Reumatoide (AR) es uno de los tipos de Artritis más frecuentes e importantes, por cuanto se trata de una enfermedad crónica y agresiva que ocasiona daño en las articulaciones, dolor e incapacidad. No tiene cura, sin embargo, existen varias líneas de tratamientos dirigidas a los síntomas y a prevenir el daño en las articulaciones y la incapacidad. De acuerdo con la Organización Mundial de la Salud (OMS), la AR es una de las mayores causas de ausentismo y retiro laboral prematuro en el mundo. Afecta entre el 1 y 1.5 % de la población mundial. El propósito fundamental de la presente revisión es plasmar las generalidades de los fármacos biológicos usados en el tratamiento de la AR, qué son, cómo se usan, tipos, efectos adversos y recomendaciones para evitar dichos efectos o tratarlos. El modelo de investigación es una revisión de tipo documental bibliográfico. De la revisión se desprende que los fármacos biológicos se usan como segunda línea de acción, en el tratamiento de pacientes con AR refractaria a los fármacos antirreumáticos modificadores de la enfermedad (FAME) sintéticos. Existen diversos tipos de estos medicamentos que varían de un país a otro, al igual que la legislación que los regula y sus costos. Asimismo, su efectividad se encuentra asociada a otros FAME, especialmente cuando se administra acompañado con metotrexato. La combinación entre FAME presenta mejores resultados que su administración única. Estos fármacos biológicos mejoran eficazmente los resultados clínicos, funcionales y radiográficos, y retrasan la progresión radiográfica en la mayoría de los casos. Por último, resulta fundamental el monitoreo de estos pacientes durante el tratamiento con FAME ya que es posible la presencia de algunos efectos secundarios.

Rheumatoid Arthritis (RA) is one of the most frequent and important types of arthritis, as it is a chronic and aggressive disease that causes joint damage, pain and disability. There is no cure, however there are several lines of treatment aimed at symptoms and preventing joint damage and disability. According to the World Health Organization (WHO), RA is one of the leading causes of absenteeism and premature retirement in the world. It affects between 1 and 1.5% of the world population. The main purpose of this review is to capture the generalities of the biological drugs used in the treatment of RA, what they are, how they are used, types, adverse effects and recommendations to avoid said effects or treat them. The research model is a bibliographic documentary type review. The review shows that biological drugs are used as a second line of action, in the treatment of patients with RA refractory to synthetic disease-modifying antirheumatic drugs (DMARDs). There are several types of these drugs that vary from one country to another, as well as the legislation that regulates them and their costs. Likewise, its effectiveness is associated with other DMARDs, especially when administered with methotrexate. The combination of DMARDs presents better results than its single administration. These biologics effectively improve clinical, functional, and radiographic outcomes, and delay radiographic progression in most cases. Lastly, it is essential to monitor these patients during DMARD treatment since the presence of some side effects is possible., La Artritis Reumatoide (AR) es uno de los tipos de Artritis más frecuentes e importantes, por cuanto se trata de una enfermedad crónica y agresiva que ocasiona daño en las articulaciones, dolor e incapacidad. No tiene cura, sin embargo, existen varias líneas de tratamientos dirigidas a los síntomas y a prevenir el daño en las articulaciones y la incapacidad. De acuerdo con la Organización Mundial de la Salud (OMS), la AR es una de las mayores causas de ausentismo y retiro laboral prematuro en el mundo. Afecta entre el 1 y 1.5 % de la población mundial. El propósito fundamental de la presente revisión es plasmar las generalidades de los fármacos biológicos usados en el tratamiento de la AR, qué son, cómo se usan, tipos, efectos adversos y recomendaciones para evitar dichos efectos o tratarlos. El modelo de investigación es una revisión de tipo documental bibliográfico. De la revisión se desprende que los fármacos biológicos se usan como segunda línea de acción, en el tratamiento de pacientes con AR refractaria a los fármacos antirreumáticos modificadores de la enfermedad (FAME) sintéticos. Existen diversos tipos de estos medicamentos que varían de un país a otro, al igual que la legislación que los regula y sus costos. Asimismo, su efectividad se encuentra asociada a otros FAME, especialmente cuando se administra acompañado con metotrexato. La combinación entre FAME presenta mejores resultados que su administración única. Estos fármacos biológicos mejoran eficazmente los resultados clínicos, funcionales y radiográficos, y retrasan la progresión radiográfica en la mayoría de los casos. Por último, resulta fundamental el monitoreo de estos pacientes durante el tratamiento con FAME ya que es posible la presencia de algunos efectos secundarios.

Rheumatoid Arthritis (RA) is one of the most frequent and important types of arthritis, as it is a chronic and aggressive disease that causes joint damage, pain and disability. There is no cure, however there are several lines of treatment aimed at symptoms and preventing joint damage and disability. According to the World Health Organization (WHO), RA is one of the leading causes of absenteeism and premature retirement in the world. It affects between 1 and 1.5% of the world population. The main purpose of this review is to capture the generalities of the biological drugs used in the treatment of RA, what they are, how they are used, types, adverse effects and recommendations to avoid said effects or treat them. The research model is a bibliographic documentary type review. The review shows that biological drugs are used as a second line of action, in the treatment of patients with RA refractory to synthetic disease-modifying antirheumatic drugs (DMARDs). There are several types of these drugs that vary from one country to another, as well as the legislation that regulates them and their costs. Likewise, its effectiveness is associated with other DMARDs, especially when administered with methotrexate. The combination of DMARDs presents better results than its single administration. These biologics effectively improve clinical, functional, and radiographic outcomes, and delay radiographic progression in most cases. Lastly, it is essential to monitor these patients during DMARD treatment since the presence of some side effects is possible., La Artritis Reumatoide (AR) es uno de los tipos de Artritis más frecuentes e importantes, por cuanto se trata de una enfermedad crónica y agresiva que ocasiona daño en las articulaciones, dolor e incapacidad. No tiene cura, sin embargo, existen varias líneas de tratamientos dirigidas a los síntomas y a prevenir el daño en las articulaciones y la incapacidad. De acuerdo con la Organización Mundial de la Salud (OMS), la AR es una de las mayores causas de ausentismo y retiro laboral prematuro en el mundo. Afecta entre el 1 y 1.5 % de la población mundial. El propósito fundamental de la presente revisión es plasmar las generalidades de los fármacos biológicos usados en el tratamiento de la AR, qué son, cómo se usan, tipos, efectos adversos y recomendaciones para evitar dichos efectos o tratarlos. El modelo de investigación es una revisión de tipo documental bibliográfico. De la revisión se desprende que los fármacos biológicos se usan como segunda línea de acción, en el tratamiento de pacientes con AR refractaria a los fármacos antirreumáticos modificadores de la enfermedad (FAME) sintéticos. Existen diversos tipos de estos medicamentos que varían de un país a otro, al igual que la legislación que los regula y sus costos. Asimismo, su efectividad se encuentra asociada a otros FAME, especialmente cuando se administra acompañado con metotrexato. La combinación entre FAME presenta mejores resultados que su administración única. Estos fármacos biológicos mejoran eficazmente los resultados clínicos, funcionales y radiográficos, y retrasan la progresión radiográfica en la mayoría de los casos. Por último, resulta fundamental el monitoreo de estos pacientes durante el tratamiento con FAME ya que es posible la presencia de algunos efectos secundarios.

Rheumatoid Arthritis (RA) is one of the most frequent and important types of arthritis, as it is a chronic and aggressive disease that causes joint damage, pain and disability. There is no cure, however there are several lines of treatment aimed at symptoms and preventing joint damage and disability. According to the World Health Organization (WHO), RA is one of the leading causes of absenteeism and premature retirement in the world. It affects between 1 and 1.5% of the world population. The main purpose of this review is to capture the generalities of the biological drugs used in the treatment of RA, what they are, how they are used, types, adverse effects and recommendations to avoid said effects or treat them. The research model is a bibliographic documentary type review. The review shows that biological drugs are used as a second line of action, in the treatment of patients with RA refractory to synthetic disease-modifying antirheumatic drugs (DMARDs). There are several types of these drugs that vary from one country to another, as well as the legislation that regulates them and their costs. Likewise, its effectiveness is associated with other DMARDs, especially when administered with methotrexate. The combination of DMARDs presents better results than its single administration. These biologics effectively improve clinical, functional, and radiographic outcomes, and delay radiographic progression in most cases. Lastly, it is essential to monitor these patients during DMARD treatment since the presence of some side effects is possible., La Artritis Reumatoide (AR) es uno de los tipos de Artritis más frecuentes e importantes, por cuanto se trata de una enfermedad crónica y agresiva que ocasiona daño en las articulaciones, dolor e incapacidad. No tiene cura, sin embargo, existen varias líneas de tratamientos dirigidas a los síntomas y a prevenir el daño en las articulaciones y la incapacidad. De acuerdo con la Organización Mundial de la Salud (OMS), la AR es una de las mayores causas de ausentismo y retiro laboral prematuro en el mundo. Afecta entre el 1 y 1.5 % de la población mundial. El propósito fundamental de la presente revisión es plasmar las generalidades de los fármacos biológicos usados en el tratamiento de la AR, qué son, cómo se usan, tipos, efectos adversos y recomendaciones para evitar dichos efectos o tratarlos. El modelo de investigación es una revisión de tipo documental bibliográfico. De la revisión se desprende que los fármacos biológicos se usan como segunda línea de acción, en el tratamiento de pacientes con AR refractaria a los fármacos antirreumáticos modificadores de la enfermedad (FAME) sintéticos. Existen diversos tipos de estos medicamentos que varían de un país a otro, al igual que la legislación que los regula y sus costos. Asimismo, su efectividad se encuentra asociada a otros FAME, especialmente cuando se administra acompañado con metotrexato. La combinación entre FAME presenta mejores resultados que su administración única. Estos fármacos biológicos mejoran eficazmente los resultados clínicos, funcionales y radiográficos, y retrasan la progresión radiográfica en la mayoría de los casos. Por último, resulta fundamental el monitoreo de estos pacientes durante el tratamiento con FAME ya que es posible la presencia de algunos efectos secundarios.

Rheumatoid Arthritis (RA) is one of the most frequent and important types of arthritis, as it is a chronic and aggressive disease that causes joint damage, pain and disability. There is no cure, however there are several lines of treatment aimed at symptoms and preventing joint damage and disability. According to the World Health Organization (WHO), RA is one of the leading causes of absenteeism and premature retirement in the world. It affects between 1 and 1.5% of the world population. The main purpose of this review is to capture the generalities of the biological drugs used in the treatment of RA, what they are, how they are used, types, adverse effects and recommendations to avoid said effects or treat them. The research model is a bibliographic documentary type review. The review shows that biological drugs are used as a second line of action, in the treatment of patients with RA refractory to synthetic disease-modifying antirheumatic drugs (DMARDs). There are several types of these drugs that vary from one country to another, as well as the legislation that regulates them and their costs. Likewise, its effectiveness is associated with other DMARDs, especially when administered with methotrexate. The combination of DMARDs presents better results than its single administration. These biologics effectively improve clinical, functional, and radiographic outcomes, and delay radiographic progression in most cases. Lastly, it is essential to monitor these patients during DMARD treatment since the presence of some side effects is possible., La Artritis Reumatoide (AR) es uno de los tipos de Artritis más frecuentes e importantes, por cuanto se trata de una enfermedad crónica y agresiva que ocasiona daño en las articulaciones, dolor e incapacidad. No tiene cura, sin embargo, existen varias líneas de tratamientos dirigidas a los síntomas y a prevenir el daño en las articulaciones y la incapacidad. De acuerdo con la Organización Mundial de la Salud (OMS), la AR es una de las mayores causas de ausentismo y retiro laboral prematuro en el mundo. Afecta entre el 1 y 1.5 % de la población mundial. El propósito fundamental de la presente revisión es plasmar las generalidades de los fármacos biológicos usados en el tratamiento de la AR, qué son, cómo se usan, tipos, efectos adversos y recomendaciones para evitar dichos efectos o tratarlos. El modelo de investigación es una revisión de tipo documental bibliográfico. De la revisión se desprende que los fármacos biológicos se usan como segunda línea de acción, en el tratamiento de pacientes con AR refractaria a los fármacos antirreumáticos modificadores de la enfermedad (FAME) sintéticos. Existen diversos tipos de estos medicamentos que varían de un país a otro, al igual que la legislación que los regula y sus costos. Asimismo, su efectividad se encuentra asociada a otros FAME, especialmente cuando se administra acompañado con metotrexato. La combinación entre FAME presenta mejores resultados que su administración única. Estos fármacos biológicos mejoran eficazmente los resultados clínicos, funcionales y radiográficos, y retrasan la progresión radiográfica en la mayoría de los casos. Por último, resulta fundamental el monitoreo de estos pacientes durante el tratamiento con FAME ya que es posible la presencia de algunos efectos secundarios.

Background: Completing prior authorizations (PAs) can be a lengthy process, which can delay access to appropriate care. A 2017 American Academy of Dermatology survey highlighted that PAs are common across many dermatologic medication classes. However, little is known regarding the impact of PAs on patient care and resource use. Methods: To better characterize the burden of PAs on dermatology practices and their effects on patient care, a survey was conducted in February 2020 among U.S.-based dermatologists (N=3,000) and the Association of Dermatology Administrators/Managers (ADAM) members (N=718). Results: Respondents reported 24% of patients require PAs. Dermatologists and staff spend a mean of 3.3 hours/day on PAs. Sixty percent of dermatologists reported interrupting patient visits for PAs. Sixty-five percent respondents reported PAs were required for clobetasol, 76% for tretinoin, and 42% for 5-fluorouracil. Respondents noted 45% of PA determinations took beyond one week and 17% took beyond two weeks. Respondents reported 12% of PAs resulted in delaying or abandoning treatment and 17% resulted in less appropriate treatment. Conclusions: Prior authorization burden remains high and consumes substantial clinical resources, which may negatively impact patient care. Additionally, they result in prolonged treatment delays and are associated with delaying treatment, abandoning treatment, or using lesser treatment.

Introduction: Emergency departments (ED) use many medications with a range of therapeutic efficacy and potential significant side effects, and many medications have dosage adjustment recommendations based on the patient’s specific genotype. How frequently medications with such pharmaco-genetic recommendations are used in United States (US) EDs has not been studied.  Methods: We conducted a cross-sectional analysis of the 2010–2015 National Hospital Ambulatory Medical Care Survey (NHAMCS). We reported the proportion of ED visits in which at least one medication with Clinical Pharmacogenetics Implementation Consortium (CPIC) recommendation of Level A or B evidence was ordered. Secondary comparisons included distributions and 95% confidence intervals of age, gender, race/ethnicity, ED disposition, geographical region, immediacy, and insurance status between all ED visits and those involving a CPIC medication. Results: From 165,155 entries representing 805,726,000 US ED visits in the 2010–2015 NHAMCS, 148,243,000 ED visits (18.4%) led to orders of CPIC medications. The most common CPIC medication was tramadol (6.3%). Visits involving CPIC medications had higher proportions of patients who were female, had private insurance and self-pay, and were discharged from the ED. They also involved lower proportions of patients with Medicare and Medicaid.  Conclusion: Almost one fifth of US ED visits involve a medication with a pharmacogenetic recommendation that may impact the efficacy and toxicity for individual patients. While direct application of genotyping is still in development, it is important for emergency care providers to understand and support this technology given its potential to improve individualized, patient- centered care.&nbsp

Rheumatoid Arthritis (RA) is one of the most frequent and important types of arthritis, as it is a chronic and aggressive disease that causes joint damage, pain and disability. There is no cure, however there are several lines of treatment aimed at symptoms and preventing joint damage and disability. According to the World Health Organization (WHO), RA is one of the leading causes of absenteeism and premature retirement in the world. It affects between 1 and 1.5% of the world population. The main purpose of this review is to capture the generalities of the biological drugs used in the treatment of RA, what they are, how they are used, types, adverse effects and recommendations to avoid said effects or treat them. The research model is a bibliographic documentary type review. The review shows that biological drugs are used as a second line of action, in the treatment of patients with RA refractory to synthetic disease-modifying antirheumatic drugs (DMARDs). There are several types of these drugs that vary from one country to another, as well as the legislation that regulates them and their costs. Likewise, its effectiveness is associated with other DMARDs, especially when administered with methotrexate. The combination of DMARDs presents better results than its single administration. These biologics effectively improve clinical, functional, and radiographic outcomes, and delay radiographic progression in most cases. Lastly, it is essential to monitor these patients during DMARD treatment since the presence of some side effects is possible., La Artritis Reumatoide (AR) es uno de los tipos de Artritis más frecuentes e importantes, por cuanto se trata de una enfermedad crónica y agresiva que ocasiona daño en las articulaciones, dolor e incapacidad. No tiene cura, sin embargo, existen varias líneas de tratamientos dirigidas a los síntomas y a prevenir el daño en las articulaciones y la incapacidad. De acuerdo con la Organización Mundial de la Salud (OMS), la AR es una de las mayores causas de ausentismo y retiro laboral prematuro en el mundo. Afecta entre el 1 y 1.5 % de la población mundial. El propósito fundamental de la presente revisión es plasmar las generalidades de los fármacos biológicos usados en el tratamiento de la AR, qué son, cómo se usan, tipos, efectos adversos y recomendaciones para evitar dichos efectos o tratarlos. El modelo de investigación es una revisión de tipo documental bibliográfico. De la revisión se desprende que los fármacos biológicos se usan como segunda línea de acción, en el tratamiento de pacientes con AR refractaria a los fármacos antirreumáticos modificadores de la enfermedad (FAME) sintéticos. Existen diversos tipos de estos medicamentos que varían de un país a otro, al igual que la legislación que los regula y sus costos. Asimismo, su efectividad se encuentra asociada a otros FAME, especialmente cuando se administra acompañado con metotrexato. La combinación entre FAME presenta mejores resultados que su administración única. Estos fármacos biológicos mejoran eficazmente los resultados clínicos, funcionales y radiográficos, y retrasan la progresión radiográfica en la mayoría de los casos. Por último, resulta fundamental el monitoreo de estos pacientes durante el tratamiento con FAME ya que es posible la presencia de algunos efectos secundarios.

Rheumatoid Arthritis (RA) is one of the most frequent and important types of arthritis, as it is a chronic and aggressive disease that causes joint damage, pain and disability. There is no cure, however there are several lines of treatment aimed at symptoms and preventing joint damage and disability. According to the World Health Organization (WHO), RA is one of the leading causes of absenteeism and premature retirement in the world. It affects between 1 and 1.5% of the world population. The main purpose of this review is to capture the generalities of the biological drugs used in the treatment of RA, what they are, how they are used, types, adverse effects and recommendations to avoid said effects or treat them. The research model is a bibliographic documentary type review. The review shows that biological drugs are used as a second line of action, in the treatment of patients with RA refractory to synthetic disease-modifying antirheumatic drugs (DMARDs). There are several types of these drugs that vary from one country to another, as well as the legislation that regulates them and their costs. Likewise, its effectiveness is associated with other DMARDs, especially when administered with methotrexate. The combination of DMARDs presents better results than its single administration. These biologics effectively improve clinical, functional, and radiographic outcomes, and delay radiographic progression in most cases. Lastly, it is essential to monitor these patients during DMARD treatment since the presence of some side effects is possible., La Artritis Reumatoide (AR) es uno de los tipos de Artritis más frecuentes e importantes, por cuanto se trata de una enfermedad crónica y agresiva que ocasiona daño en las articulaciones, dolor e incapacidad. No tiene cura, sin embargo, existen varias líneas de tratamientos dirigidas a los síntomas y a prevenir el daño en las articulaciones y la incapacidad. De acuerdo con la Organización Mundial de la Salud (OMS), la AR es una de las mayores causas de ausentismo y retiro laboral prematuro en el mundo. Afecta entre el 1 y 1.5 % de la población mundial. El propósito fundamental de la presente revisión es plasmar las generalidades de los fármacos biológicos usados en el tratamiento de la AR, qué son, cómo se usan, tipos, efectos adversos y recomendaciones para evitar dichos efectos o tratarlos. El modelo de investigación es una revisión de tipo documental bibliográfico. De la revisión se desprende que los fármacos biológicos se usan como segunda línea de acción, en el tratamiento de pacientes con AR refractaria a los fármacos antirreumáticos modificadores de la enfermedad (FAME) sintéticos. Existen diversos tipos de estos medicamentos que varían de un país a otro, al igual que la legislación que los regula y sus costos. Asimismo, su efectividad se encuentra asociada a otros FAME, especialmente cuando se administra acompañado con metotrexato. La combinación entre FAME presenta mejores resultados que su administración única. Estos fármacos biológicos mejoran eficazmente los resultados clínicos, funcionales y radiográficos, y retrasan la progresión radiográfica en la mayoría de los casos. Por último, resulta fundamental el monitoreo de estos pacientes durante el tratamiento con FAME ya que es posible la presencia de algunos efectos secundarios.