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Guidelines recommend delayed cord clamping (DCC) of at least 30 s for vigorous preterm infants who do not require resuscitation. It is not known whether DCC affects the rate of crying and breathing after birth. We reviewed videos of 80 preterm infants in the delivery room. Most infants cried and breathed after both immediate and delayed cord clamping before respiratory support was given. Infants arrived at the resuscitaire in similar physiological condition, regardless of the time after birth at which they arrived. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess the feasibility of a medication sampling program involving community pharmacists. Methods: A community pharmacy dispensed samples after receiving a voucher given to patients by prescribers. Surveys explored prescribers’ and patients’ views about sampling and patients’ experiences with the program. Key findings: Half of prescribers reported providing samples, yet 15 patients redeemed 18 vouchers over 1 year. Patients expressed favourable views towards sampling and pharmacist involvement, despite more than half (n = 8/15, 53%) feeling that visiting the pharmacy was less convenient. Conclusion: A voucher‐based medication sampling program based in a community pharmacy is a model integrating pharmacist care. [ABSTRACT FROM AUTHOR]

Aims: Certain combinations of medications can be harmful and may lead to serious adverse drug events (ADEs). Identifying potentially problematic medication clusters could help guide prescribing and/or deprescribing decisions in hospital. The aim of this study is to characterize medication prescribing patterns at hospital discharge and determine which medication clusters were associated with an increased risk of ADEs in the 30‐day posthospital discharge. Methods: All residents of the province of Ontario in Canada aged 66 years or older admitted to hospital between March 2016 and February 2017 were included. Identification of medication clusters prescribed at hospital discharge was conducted using latent class analysis. Cluster identification and categorization were based on medications dispensed up to 30‐day posthospitalization. Multivariable logistic regression was used to assess the potential association between membership to a particular medication cluster and ADEs postdischarge, while also evaluating other patient characteristics. Results: In total, 188 354 patients were included in the study cohort. Median age (interquartile range) was 77 (71–84) years, and patients had a median (IQR) (interquartile range [IQR]) of 9 (6–13) medications dispensed prior to admission. Within the study population, 6 separate clusters of dispensing patterns were identified: cardiovascular (14%), respiratory (26%), complex care needs (12%), cardiovascular and metabolic (15%), infection (10%), and surgical (24%). Overall, 12 680 (7%) patients had an ADE in the 30 days following discharge. After considering other patient characteristics, those belonging to the respiratory cluster had the highest risk of ADEs (adjusted odds ratio: 1.12, 95% confidence interval: 1.08–1.17) compared with all the other clusters, while those in the complex care needs cluster had the lowest risk (adjusted odds ratio: 0.82, 95% confidence interval: 0.77–0.87). Conclusion: This study suggests that ADEs post hospital discharge can be linked with identifiable medication clusters. This information may help clinicians and researchers better understand patient populations that are more or less likely to benefit from peri‐hospital discharge interventions aimed at reducing ADEs. PLAIN LANGUAGE SUMMARY: Certain combinations of medications prescribed to patients when they are being discharged from hospital can increase the risk of adverse events after hospital discharge. [ABSTRACT FROM AUTHOR]

Background: Recognizing the potential effect of sex and gender on health outcomes, there is a shift toward conducting sex and gender-based analysis (SGBA) within health research. However, little is known about the extent to which SGBA has been incorporated into pharmacy practice research.Objectives: To understand the extent to which SGBA is included in pharmacy practice research.Method: Scoping review of English-language studies identified through MEDLINE, Embase, International Pharmacy Abstracts (IPA), and CINAHL (inception to Jan 2014). Two raters independently screened citations to identify titles and abstracts that included key words related to sex or gender and studies that could be categorized as pharmacy practice research. One author extracted data from included studies related to study design, population, intervention/exposure and outcomes, with results reviewed by another. All authors reviewed eligible articles to categorize them based on a previously-developed typology, and to assess four criteria: 1) the inclusion of sex or gender in research objectives, 2) the depth of sex/gender analysis incorporated into study designs and reporting, 3) the inclusion of sex or gender considerations in interpretation of study results, 4) the intentional and accurate use of sex/gender language.Results: Of 458 unique search results, only six articles met the inclusion criteria. Two of these six publications included sex/gender considerations in a model consistent with sex/gender based analysis as described by Hammarström. Three of the six studies inaccurately applied sex and gender terminology, whereas the two studies that featured sex or gender in their primary research question did use these terms appropriately.Conclusion: Despite increasing attention on the need for considering sex and gender, there was a paucity of pharmacy practice research publications that conducted SGBA. This presents an opportunity to explore sex, gender and intersectionality when pursuing studies that explore the impact of pharmacists interventions on patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Individualizing glycemic targets to goals of care and time to benefit in persons with type 2 diabetes is good practice, particularly in populations at risk of hypoglycemia and adverse outcomes relating to the use of antihyperglycemics. Guidelines acknowledge the need for relaxed targets in frail older adults, but there is little guidance on how to safely deprescribe (i.e. stop, reduce or substitute) antihyperglycemics. Methods: The purpose of this study was to synthesize evidence from all studies evaluating the effects of deprescribing versus continuing antihyperglycemics in older adults with type 2 diabetes. To this end, we searched MEDLINE, EMBASE, and Cochrane Library (July 2015) for controlled studies evaluating the effects of deprescribing antihyperglycemics in adults with type 2 diabetes. All such studies were eligible for inclusion in our study, and two independent reviewers screened titles, abstracts and full-text articles, extracted data, and evaluated risk of bias. Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment and a narrative summary were completed. Results: We identified two controlled before-and-after studies, both of very low quality. One study found that an educational intervention decreased glyburide use while not compromising glucose control. The other reported that cessation of antihyperglycemics in elderly nursing home patients resulted in a non-significant increase in glycated hemoglobin (HbA1C). No significant change in hypoglycemia rate was found in the only study with this outcome measure. Conclusions: There is limited evidence available regarding deprescribing antihyperglycemic medications. Adequately powered, high-quality studies, particularly in the elderly and with clinically important outcomes, are required to support evidence-based decision-making. Protocol registration number: CRD42015017748. [ABSTRACT FROM AUTHOR]

Continuous increases of acoustic intensity ( up- ramps) can indicate a looming (approaching) sound source in the environment, whereas continuous decreases of intensity ( down- ramps) can indicate a receding sound source. From psychoacoustic experiments, an 'adaptive perceptual bias' for up-ramp looming tonal stimuli has been proposed (Neuhoff, 1998). This theory postulates that (1) up-ramps are perceptually salient because of their association with looming and potentially threatening stimuli in the environment; (2) tonal stimuli are perceptually salient because of an association with single and potentially threatening biological sound sources in the environment, relative to white noise, which is more likely to arise from dispersed signals and nonthreatening/nonbiological sources (wind/ocean). In the present study, we extrapolated the 'adaptive perceptual bias' theory and investigated its assumptions by measuring sound source localization in response to acoustic stimuli presented in azimuth to imply looming, stationary, and receding motion in depth. Participants ( N = 26) heard three directions of intensity change (up-ramps, down-ramps, and steady state, associated with looming, receding, and stationary motion, respectively) and three levels of acoustic spectrum (a 1-kHz pure tone, the tonal vowel /ә/, and white noise) in a within-subjects design. We first hypothesized that if up-ramps are 'perceptually salient' and capable of eliciting adaptive responses, then they would be localized faster and more accurately than down-ramps. This hypothesis was supported. However, the results did not support the second hypothesis. Rather, the white-noise and vowel conditions were localized faster and more accurately than the pure-tone conditions. These results are discussed in the context of auditory and visual theories of motion perception, auditory attentional capture, and the spectral causes of spatial ambiguity. [ABSTRACT FROM AUTHOR]

Background: Policy-makers and health professionals' views about pharmacist prescribing have been well studied, but less is known about the views of the public and patients.Objective: To describe from existing literature the views and experiences of patients as well as the views of the public about pharmacist prescribing.Methods: Sources: Medline, EMBASE, and International Pharmaceutical Abstracts from inception to November 2015; reference lists of included studies.Inclusion Criteria: English-language studies describing the views and experiences of patients and the views of the public about pharmacist prescribing. Two reviewers independently screened titles and abstracts and one reviewer charted data. The University of British Columbia Patient Experience Framework was used to categorize and synthesize findings about patients' experience. Views were described using a descriptive thematic synthesis approach.Results: Out of 2377 unique records, 35 articles were reviewed in full for eligibility. Three studies were excluded because participants were not patients or the public, eight studies were not about prescribing, and four studies were abstracts. Two articles were identified from the bibliographies of included studies. In total, twenty-two studies met inclusion criteria. Fourteen studies were quantitative (63.6%), six were qualitative (27.3%) and two were mixed design (9.1%) studies. Four studies (18.2%) were conducted in Canada (Saskatchewan, Newfoundland and Labrador, Nova Scotia), one (4.5%) in Australia, one (4.5%) in the United States (Washington) and the remaining in the United Kingdom (n = 16, 72.7%). The most commonly explored dimensions of patient experiences were access, interpersonal communication, and patient-reported impacts of care. Patients reported high satisfaction with appointment times, communication with the pharmacist prescriber and the services received. The public supported pharmacist prescribing in limited situations (chronic conditions, minor ailments, repeat medications). The public were concerned about privacy during consultations but patients were less so. Both patients and the public shared concerns regarding lack of adequate resources to ensure safe prescribing by pharmacists (e.g., lack of pharmacists' access to medical records, lack of additional staff support to fulfill prescribing responsibilities).Conclusion: Patients' experiences with pharmacist prescribing were generally positive. There were shared concerns between patients and the public about pharmacist prescribing. Opportunities for further research include strategies for building public experience with pharmacist prescribing and methods for addressing concerns identified by patients and the public. [ABSTRACT FROM AUTHOR]

The article presents a study which aims to develop a program to incorporate MedsCheck community pharmacy program into an ambulatory clinic workflow. The study shows that 54 patients consented to have contacted their community pharmacy and documentation was obtained for 21. It reveals that medical residents reported an estimated 7.9 minutes mean appointment time savings.

Background: Clinicians and patients often face a decision to continue or discontinue statins. We examined the impact of discontinuation of statins compared with continuation on clinical outcomes (all‐cause mortality, cardiovascular [CV] mortality, CV events, and quality of life). Methods: We conducted a systematic review. Randomized controlled trials (RCTs), cohort studies, case–control studies, and quasi‐randomized studies among people ≥18 years were eligible. We searched MEDLINE, Embase, and Cochrane Central Registry (inception to August 2023). Two independent reviewers performed screening and extracted data. Quality assessment was performed by one author and verified by another. We summarized results narratively, performed meta‐analysis for a subset of studies, and used GRADE to assess certainty of evidence. We summarized findings in the subgroup of persons ≥75 years. Results: We retrieved 8369 titles/abstracts; 37 reports from 36 studies were eligible. This comprised 35 non‐randomized studies (n = 1,708,684) and 1 RCT (n = 381). The 1 RCT was conducted among persons with life expectancy <1 year and showed there is probably no difference in 60‐day mortality (risk difference = 3.5%, 90% CI −3.5 to 10.5) for statin discontinuation compared with continuation. Non‐randomized studies varied in terms of population and setting, but consistently suggested that statin discontinuation might be associated with a relative increased risk of mortality (hazard ratio (HR) 1.92, 95% CI 1.52 to 2.44, nine studies), CV mortality (HR 1.63, 95% CI 1.27 to 2.10, five reports), and CV events (HR 1.31, 95% CI 1.23 to 1.39, eight reports). Findings in people ≥75 years were consistent with main results. There was a high degree of uncertainty in findings from non‐randomized studies due to methodological limitations. Conclusions: Statin discontinuation does not appear to affect short‐term mortality near end‐of‐life based on one RCT. Outside of this population, findings from non‐randomized studies consistently suggested statin discontinuation may be associated with worse outcomes, though this is uncertain. See related Editorial by Odden and Dave. [ABSTRACT FROM AUTHOR]

Background: Adults with spinal cord injury/dysfunction (SCI/D) face challenges with medications they take to manage their secondary conditions (e.g., pain, urinary tract infections, autonomic dysreflexia). With many healthcare providers typically involved in care, there are additional challenges with care fragmentation and self-management. Prior research emphasized the desire for more support with medication self-management among this population. Objective: To explore what content should be included in a medication self-management resource (i.e., toolkit) for adults with SCI/D, as well as considerations for delivery from the perspectives of adults with SCI/D, caregivers, healthcare providers, and representatives from community organizations. Methods: A concept mapping study was conducted. Participants took part in one or more of three activities: brainstorming; sorting and rating; and mapping. Participants generated ideas about the content to include in a medication self-management toolkit. Participants sorted the statements into conceptual piles and assigned a name to each. All statements were rated on a five-point Likert-type scale on importance and realistic to include in the toolkit. Participants decided on the final cluster map, rearranged statements, and assigned a name to each cluster to create visual representations of the data. Results: Forty-four participants took part in this study. The final map contained eight clusters: 1) information-sharing and communication; 2) healthcare provider interactions and involvement; 3) peer and community connections; 4) supports and services for accessing prescription medications and medication information; 5) information on non-prescription medication and medication supplies; 6) safety and lifestyle considerations; 7) general medication information; and 8) practical information and strategies related to medication-taking. Safety and lifestyle considerations was rated as the most important and realistic to include in the toolkit. Conclusions: Given the limited tools to help adults with SCI/D with managing their medications, there is great potential to better support this population across all areas of medication self-management. [ABSTRACT FROM AUTHOR]

Background/rationale Objective Methods Findings Conclusions Weekly cholecalciferol can replace daily supplementation to reduce pill burden in patients with complex medication regimens and hypovitaminosis D, but evidence supporting this switch is unclear.We aimed to determine whether weekly cholecalciferol was superior to daily cholecalciferol to replete patients with hypovitaminosis D.We conducted a systematic review of randomized controlled trials involving participants with baseline hypovitaminosis D (<30 ng/ml) comparing weekly versus daily cholecalciferol dosing and where serum cholecalciferol was measured within 120 days of starting treatment. We searched MEDLINE, CINAHL and EMBASE from inception to 7 May 2024. A random‐effects meta‐analysis evaluated the odds ratio for repletion of serum vitamin D levels.Eight trials involving 542 patients were included in the analysis. Weekly and daily cholecalciferol were not significantly different in correcting hypovitaminosis D (OR = 1.5, 95% CI = 0.3–6.9, p = 0.6, favouring weekly dosing, I2 = 85.3%). A sensitivity analysis excluding otherwise healthy patients had similar findings (OR = 0.8, 95% CI = 0.3–2.1, p = 0.6). Most studies were at risk of bias; the different doses being compared increased the heterogeneity.Limited direct evidence supports a switch from daily to weekly cholecalciferol dosing; however, weekly supplementation was not demonstrably worse at repleting levels and decreased a patient's daily pill burden. [ABSTRACT FROM AUTHOR]

The article discusses the issue of polypharmacy and its negative health outcomes, particularly among older adults in Canada. It introduces the Canadian Medication Appropriateness and Deprescribing Network (CADeN) and describes the goals and outcomes of the CADeN 2023 National Meeting, which focused on strengthening relationships, sharing resources, and informing policy. The meeting emphasized equity, diversity, and inclusion, as well as the importance of indigenous perspectives in healthcare. Initiatives and research on medication appropriateness and deprescribing were discussed, along with strategies to reduce medication overload. The meeting highlighted the need for health policy reforms, equitable access to medications, patient engagement, and collaboration within the healthcare system. The CADeN network plans to continue its efforts to promote medication appropriateness in Canada. [Extracted from the article]

The MMPI-A normative sample (805 males, 815 females) and an adolescent clinical sample (266 males, 92 females) were used to investigate the factor structure of the MMPI-A content scales. Principal factor analyses were conducted on scale-level raw score data for the set of 15 MMPI-A content scales, and item-level factor analyses were also conducted for each individual content scale. Scale-level analyses yielded a 2-factor solution for boys in the normative sample and for the combined clinical groups, and a 1-factor solution for the combined normative sample and for gifts in the normative group. The 2 factors were labeled General Maladjustment and Externalizing Tendencies. Further, item-level analyses produced 1-factor solutions for the majority of the MMPI-A content scales. These findings were compared with the results of other MMPI-A studies, including Sherwood, Ben-Porath, and Williams's (1997) recently developed MMPI-A Content Component scales. Implications of these findings are discussed in terms of approaches to interpreting the MMPI-A content scales. [ABSTRACT FROM AUTHOR]

The effectiveness of hospital social work preadmission screening and assessment is compared with postadmission screening and assessment. Outcome variables include length of stay, readmission rates, posthospital home management, resource attainment, and satisfaction with hospital services. The patients screened postadmission were assessed within forty-eight hours of admission, while the patients screemed preadmission were assessed one to two week prior to admission. Telephone follow-up was conducted with both groups. Preadmission patients reported better home management and attained more resources. Patients' satisfaction with hospital care was inversely related to the need for more resources in the post-hospital period. [ABSTRACT FROM PUBLISHER]

Background: Prescribing cascades occur when the side effect of a medication is treated with a second medication. The aim of the study was to understand how prescribing cascades develop and persist and to identify strategies for their identification, prevention and management.Method: This qualitative study employed semi-structured interviews to explore the existence of prescribing cascades and to gather patients', caregivers' and clinicians' perspectives about how prescribing cascades start, persist and how they might be resolved. Participants were older adults (over age 65) at an outpatient Geriatric Day Hospital (GDH) with possible prescribing cascades (identified by a GDH team member), their caregivers, and healthcare providers. Data were analyzed using an inductive content analysis approach.Results: Fourteen participants were interviewed (eight patients, one family caregiver, one GDH pharmacist, three GDH physicians and one family physician) providing a total of 22 interviews about patient-specific cases. The complexity and contextually situated nature of prescribing cascades created challenges for all of those involved with their identification. Three themes impacted how prescribing cascades developed and persisted: varying awareness of medications and cascades; varying feelings of accountability for making decisions about medication-related care; and accessibility to an ideal environment and relevant information. Actions to prevent, identify or resolve cascades were suggested.Conclusion: Patients and healthcare providers struggled to recognize prescribing cascades and identify when they had occurred; knowledge gaps contributed to this challenge and led to inaction. Strategies that equip patients and clinicians with resources to recognize prescribing cascades and environmental and social supports that would help with their identification are needed. Current conceptualizations of cascades warrant additional refinement by considering the nuances our work raises regarding their appropriateness and directionality. [ABSTRACT FROM AUTHOR]

Presents information on the levonorgestrel-releasing intrauterine system. Comparison with other contraceptives; Tolerability issue with the device; Effectiveness of the device; Cost of the intrauterine device.

In this systematic review, we report on the effects of diuretic deprescribing compared to continued diuretic use. We included clinical studies reporting on outcomes such as mortality, heart failure recurrence, tolerability and feasibility. We assessed risk of bias and certainty of the evidence using the GRADE framework. We included 25 publications from 22 primary studies (15 randomized controlled trials; 7 nonrandomized studies). The mean number of participants in the deprescribing groups was 35, and median/mean age 64 years. In patients with heart failure, there was no clear evidence that diuretic deprescribing was associated with increased mortality compared to diuretic continuation (low certainty evidence). The risk of cardiovascular composite outcomes associated with diuretic deprescribing was inconsistent (studies showing lower risk for diuretic deprescribing, or comparable risk with diuretic continuation; very low certainty evidence). The effect on heart failure recurrence after diuretic deprescribing in patients with diuretics for heart failure, and of hypertension in patients with diuretics for hypertension was inconsistent across the included studies (low certainty evidence). In patients with diuretics for hypertension, diuretic deprescribing was well tolerated (moderate certainty evidence), while in patients with diuretics for heart failure, deprescribing diuretics can result in complaints of peripheral oedema (very low certainty evidence). The overall risk of bias was generally high. In summary, this systematic review suggests that diuretic discontinuation could be a safe and feasible treatment option for carefully selected patients. However, there isa lack of high‐quality evidence on its feasibility, safety and tolerability of diuretic deprescribing, warranting further research. [ABSTRACT FROM AUTHOR]