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Background Obsessive-compulsive disorder (OCD) patients have specific cognitive, emotional and behavioral dysfunctions that are both a consequence and a cause of altered brain structure and function. The ENIGMA consortium was founded to advance our understanding of the neurobiology of brain disorders (Thompson et al., 2020), including OCD, by using worldwide data. This is the largest OCD brain imaging consortium established to date, who’s combined sample includes thousands of OCD patients, both adult and pediatric, and healthy controls. Using structural MRI, diffusion MRI, and resting state functional MRI analyses, the ENIGMA-OCD consortium has already found that some OCD-related brain alterations may arise during neurodevelopment, while others are associated with duration of illness or medication use (van den Heuvel et al., 2022). Now the time has come to embark on a new phase of the ENIGMA-OCD consortium with a focus on OCD-related alterations in brain function during specific emotional and cognitive states. One functional domain known to be disrupted in OCD is emotional processing, subserved by the fronto-limbic circuit that encompasses the amygdala and ventromedial prefrontal cortex (consisting of ventral orbitofrontal cortex, subgenual anterior cingulate cortex, and the ventral part of the medial frontal gyrus) (Shephard et al., 2021). Across the ENIGMA-OCD consortium, various emotional tasks have been used to investigate the function of the fronto-limbic circuit in OCD during MRI, including the emotional Stroop task, the symptom provocation task, and the emotional faces task. Each of these tasks probes the domain in a different way, but it ultimately boils down to one basic contrast: emotional vs. neutral processing that we can use to study the functional differences between patients and controls across different tasks. Two meta-analyses have already compared OCD patients and healthy controls on emotional processing (Rotge et al., 2008; Thorsen et al., 2018), but these relied on coordinate-based meta-analytic methods using information from published results, that necessarily discard a large amount of information. Our approach pools individual participant fMRI data collected consortium-wide (both published and unpublished data) into an image-based mega-analysis, the first of its kind in OCD. The meta-analysis of Thorsen et al. (2018), based on 25 published studies, found that during emotional processing, OCD patients showed increased activation in the amygdala, OFC extending into the subgenual anterior cingulate and ventromedial prefrontal cortex, putamen, and middle temporal and inferior occipital regions, relative to healthy controls. Several patient factors were found to influence these results. Medication usage in the samples investigated was shown to correlate with activation in the right amygdala and left inferior occipital gyrus, indicating less hyperactivation of these areas in medicated as compared to unmedicated patients. Symptom severity was shown to correlate with activation in the subgenual and rostral ACC, and medial PFC. An effect of duration of illness was found, as samples with longer mean duration exhibited increased activation in the right putamen and decreased activation in the left temporal pole and orbitofrontal cortex. The smaller meta-analysis of Rotge et al. (2008), based on 8 published studies, found comparable differences between OCD patients and healthy controls in the OFC, ACC, temporal gyrus and anterior parts of the PFC, but also found increased activation in the medial PFC, globus pallidus, hippocampus, thalamus. These discordant results may be the product of reduced power and greater noise in the smaller meta-analysis. We use a newly-developed fMRI processing pipeline, ENIGMA HALFpipe, to harmonize preprocessing, first-level, and group-level analyses across sites (Waller et al., 2022). With the unprecedented power we now have to study disorder-related changes in neurobiology, we hope to validate previous findings in OCD, and to test how well they generalize to diverse populations worldwide.

Continuous-flow left ventricular assist devices are frequently used for management of patients with advanced heart failure with reduced ejection fraction. Although technologic advancements have contributed to improved outcomes, several complications arise over time. These complications result from several factors, including medication effects, physiologic responses to chronic exposure to circulatory support that is minimally/entirely nonpulsatile, and dysfunction of the device itself. Clinical presentation can range from chronic and indolent to acute, life-threatening emergencies. Several areas of uncertainty exist regarding best practices for managing complications; however, growing awareness has led to development of new guidelines to reduce risk and improve outcomes.

Parkinson's disease (PD) is a neurological disorder associated primarily with overt motor symptoms. Several studies show that PD is additionally accompanied by impairments in covert cognitive processes underlying goal-directed motor functioning (e.g., action planning, conflict adaptation, inhibition), and that dopaminergic medication may modulate these action control components. In this review we aim to leverage findings from studies in this domain to elucidate the role of dopamine (DA) in action control. A qualitative review of studies that investigated the effects of medication status (on vs. off) on action control in PD suggests a component-specific role for DA in action control, although the expression of medication effects depends on characteristics of both the patients and experimental tasks used to measure action control. We discuss these results in the light of findings from other research lines examining the role of DA in action control (e.g., animal research, pharmacology), and recommend that future studies use multi-method, within-subject approaches to model DA effects on action control across different components as well as underlying striatal pathways (ventral vs. dorsal).

Objective: We aimed to (1) examine differences in observed visual attention and motor activity, as well as comprehension of a science video between children with and without attention-deficit/hyperactivity disorder (ADHD) and (2) explore if psychostimulant medication improves ADHD behaviors and comprehension of a science video in children with ADHD. Method: Children aged 7–11 with (n = 91) and without (n = 45) ADHD watched a science video and then completed a comprehension test. Then, children with ADHD began a 4-week within-subject, randomized, double-blind crossover trial of methylphenidate (MPH). At post-testing, children were randomized to receive placebo or their optimal dosage, watched another science film, and completed a comprehension test. Results: Children with ADHD exhibited higher rates of motor activity during, and worse comprehension of material discussed within, the science video. Mediation models revealed that increased motor activity suppressed between-group differences in comprehension. MPH improved comprehension and visual attention, but not motor activity during the science video. Conclusion: Children with ADHD may benefit from MPH to improve comprehension of and sustained attention during audiovisually presented learning material.

Efrat Neter,1 Lea Glass-Marmor,2 Loren Haiien,2 Ariel Miller2,3 1Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel; 2Multiple Sclerosis Center & Department of Neurology, Carmel Medical Center, Haifa, Israel; 3Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, IsraelCorrespondence: Efrat NeterDepartment of Behavioral Sciences, Ruppin Academic Center, 3 Bait, Emeq Hefer, 4025000, IsraelTel +972-54-6462677Fax +972-9-8983043Email neter@ruppin.ac.ilBackground: As the number of treatment options for multiple sclerosis (MS) has expanded, alignment between physician and patient on effects of medication has emerged as important for medication persistence/discontinuation.Objective: To evaluate physician–patient agreement levels on medication effect and health status.Methods: Persons with MS (PwMS) (n=71) participated in a cross-sectional study collecting their satisfaction (using the Treatment Satisfaction Questionnaire for Medication), intention to dis/continue treatment and global health perception; physicians assessed response to medication and global health status.Results: Concordance between PwMS’ assessment of medication effectiveness and physician’s assessment on response to medication, health status and EDSS were rs= 0.50, rs= 0.57 and rs= − 0.58, respectively.Conclusion: The significant concordance attests to physician–patient effective communication and may contribute to improved medication adherence.Keywords: concordance, disease-modifying therapy, patient-centered approach, multiple sclerosis, patient-reported outcomes, participatory medicine

The treatment of gout with allopurinol is effective at reducing urate levels and the frequency of flares. Several observational studies have shown important reductions in mortality with allopurinol use, with wide variations in results. We undertook this review to assess the extent of bias in these studies, particularly time-related biases such as immortal time bias.We searched the literature to identify all observational studies describing the effect of allopurinol use versus nonuse on all-cause mortality.We identified 12 observational studies, of which 3 were affected by immortal time bias and 3 by immeasurable time bias, while the remaining 6 studies avoided these time-related biases. Reductions in all-cause mortality with allopurinol use were observed among the studies with immortal time bias, with a pooled hazard ratio (HR) of death associated with allopurinol of 0.71 (95% confidence interval [95% CI] 0.50-1.01), as well as in those with immeasurable time bias (pooled HR 0.62 [95% CI 0.56-0.67]). The 6 studies that avoided these biases demonstrated a null effect of allopurinol on mortality (pooled HR 0.99 [95% CI 0.87-1.11]), though the lack of an analysis based on treatment adherence may have attenuated the effect.Observational studies are important to provide real-world data on medication effects. The observational studies showing significantly decreased mortality with allopurinol treatment cannot be used as evidence, however, mainly due to time-related biases that tend to greatly exaggerate the potential benefit of treatments. The ALL-HEART randomized trial, which is currently underway and evaluates the effect of adding allopurinol to usual care (compared to no added treatment), will provide reliable evidence on mortality.

Growing uses of opioids for pain management have led to a crisis of addiction and thousands of deaths in the United States. Although many of the opioid effects have been observed and reported, experience directly from the opioid users may help provide additional information in identifying any potentially unreported effects. In this study, we developed a neural embedding-based method to discover potential opioid-effect relations through similar relations of known medication effects. Using a corpus of 3.6 million clean unannotated tweets, a vector space model was learned with word2vec, and the model was used to identify potential opioid effects. The inferred results were further verified against 5 authoritative sources of medication effects. Seven of inferred effects were identified as potentially unreported, demonstrating the power and utility of our method. It is conceivable that our approach can be applied to discovery of potentially unreported effects of other medications.

Drug-induced injury to the gastrointestinal tract is fairly common, often with important clinical consequences. An aging population, coupled with an ever-expanding drug industry, and availability of a bewildering array of both prescription and over-the-counter medications offer increasing opportunities to encounter unwarranted side effects from different medications. Several factors such as dose, mechanism of action, drug interactions, and the individual’s underlying health status can influence the type and severity of medication effects. Mucosal damage may occur due to direct physical injury or by altering mucosal immunity and local environmental milieu. Pathologic changes induced by medications are varied, often non-specific, and can mimic various diseases, including neoplasms. An awareness of the spectrum of pathologic changes induced by various drugs is important in establishing a temporal relationship and avoiding misdiagnosis.

Language disturbances are key aberrations in schizophrenia. Little is known about the influence of antipsychotic medication on these symptoms. Using computational language methods, this study evaluated the impact of high versus low dopamine D2 receptor (D2R) occupancy antipsychotics on language disturbances in 41 patients with schizophrenia, relative to 40 healthy controls. Patients with high versus low D2R occupancy antipsychotics differed by total number of words and type-token ratio, suggesting medication effects. Both patient groups differed from the healthy controls on percentage of time speaking and clauses per utterance, suggesting illness effects. Overall, more severe negative language disturbances (i.e. slower articulation rate, increased pausing, and shorter utterances) were seen in the patients that used high D2R occupancy antipsychotics, while less prominent disturbances were seen in low D2R occupancy patients. Language analyses successfully predicted drug type (sensitivity = 80.0%, specificity = 76.5%). Several language disturbances were more related to drug type and dose, than to other psychotic symptoms, suggesting that language disturbances may be aggravated by high D2R antipsychotics. This negative impact of high D2R occupancy drugs may have clinical implications, as impaired language production predicts functional outcome and degrades the quality of life.

The quality of life (QoL) perception over time in adult people with epilepsy (PWE) is important to define strategies of conduct. Objective The aim of this study was to assess the minimally important change (MIC) threshold of the Quality of Life in Epilepsy Inventory-31 (QOLIE-31) of PWE over a period of 4 years and its relationship with clinical epilepsy variables. Methods A total of 129 PWE (46 ± 14.3 years) were included, and the clinical aspects of epilepsy and the QOLIE-31 were assessed in the initial and final assessment, with p Results The emotional well-being (− 6.31) and social functioning (− 5.36) showed clinically relevant effects between the assessments. Quality of life was compromised by increasing the number of antiepileptic drugs (AED) taken [total score (− 8.53), social functioning (− 14.70)] or by maintaining the use of polytherapy [social functioning (− 12.89)]. Fewer seizures were associated with a better QoL [total score (7.99), social (17.88) and cognitive functioning (16.30)]. The reduction in seizures was not associated with a better QoL [total and social functioning score], and the increase in seizures did not change QoL perception (cognitive functioning). There was a reduction in the QoL perception in medication effects in temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) (8.92) and with an increase in age in one year (− 0.44). Conclusions Quality of life was compromised in the emotional well-being and social functioning during the 4-year follow-up period. The increase in the number of AED taken and age and the TLE-HS compromised QoL changes in the frequency of seizures not associated with a significant improvement in QoL.

Chronic obstructive pulmonary disease (COPD) is a common disease that is characterized by progressive and irreversible airflow limitation and frequent symptoms of breathlessness and productive cough. COPD is caused by chronic exposure to noxious particles, usually cigarette smoke, but certain genetic, epigenetic, and environmental factors contribute to its development and phenotypes. Exhaled biomarkers in COPD have been investigated in numerous, but currently none of these measurements are endorsed by clinical guidelines or recommendations. In this chapter, we critically review the published literature on exhaled breath condensate (EBC), particles, volatile organic compounds (VOCs), nitric oxide (NO), carbon monoxide (CO), and temperature in COPD, focusing on methodological challenges, smoking, and medication effects.

Background: Evaluating the effects of anti-seizure medication and response to treatment in patients with epilepsy remains a slow, challenging and manual process. A digital biomarker for medication effects and/or epileptogenicity would provide useful and objective information that guides clinical decision making. The aim of this study is to determine if the effect of anti-seizure medications on patients with epilepsy can be quantitatively measured in near real-time from electroencephalography (EEGs). Methods: We screened patients admitted to the Long-Term Monitoring Unit at Boston Children’s Hospital for pre-surgical evaluation. We selected two 30-second EEG excerpts from a period before and after medication weaning, were selected for nonlinear analysis from each patient. Findings: We found measurable effects of anti-seizure medications across all nonlinear measures of patients on high or low amounts on medication. Patients with a moderate number of expected seizures per day showed a larger medication effect on the brain than patients with rare or frequent seizures. Patients on four or more medications showed the largest effect size pre- and post- medication weaning. The seizure onset zone of the brain responded differently to medication than the rest of the brain. Patients with a clinically-determined lack of response to medication had distinctly different brain electrodynamics compared to patients who did have a response to medication. These medication effects correlate with the inferred level of epileptogenicity in a patient’s brain. Interpretation: Multifrequency nonlinear EEG analysis shows promise for identifying digital biomarkers to measure medication effects and evaluate response to treatment in patients with epilepsy. Funding Statement: Dr. Sathyanarayana was supported by T32HD040128 from the NICHD/NIH. TL, REA, and MJ were supported by the Epilepsy Research Fund. Declaration of Interests: WJB and TL are named on a patent submitted and held by the Boston Children’s Hospital Technology Development Office that includes the signal analysis methods discussed in this article. TL is part of patent applications to detect and predict clinical outcomes, and to manage, diagnose, and treat neurological conditions, epilepsy, and seizures. The other authors declare that they have no other competing financial or non-financial interests. Ethics Approval Statement: The Institutional Review Board approved the study prior to data acquisition, and was deemed exempt from consent.

Myelodysplastic syndromes (MDS) are often challenging to diagnose accurately. Diagnostic criteria for MDS include subjective morphologic interpretations or findings of low specificity. There exist several MDS “mimics” that share findings with MDS but are caused by more benign conditions, other neoplasms, or less well-characterized pre-malignant states. Vitamin and iron deficiencies need to be excluded along with autoimmune conditions, medication effects, toxic exposures, viral infections, and congenital syndromes. We now recognize mutational events common to patients with MDS. However, most somatic events indicative of clonal hematopoiesis are not synonymous with MDS as they are found in other myeloid disorders and clonal cytopenias that fail to meet diagnostic criteria for MDS. Interpretation of molecular findings depends on the clinical context in which they occur as the same somatic mutations can have different clinical implications in different settings. This chapter will highlight common MDS mimics with special attention to potentially pre-malignant states.

Patients' beliefs about their prescribed medication are an important factor influencing intentional non-adherence. This study describes rheumatoid arthritis (RA) patients' beliefs about their subcutaneous (SC) biological medication through the Beliefs about Medicines Questionnaire (BMQ), and potential associations. As part of the ARCO study (Study on Adherence of Rheumatoid arthritis patients to subCutaneous and Oral drugs), patients completed the BMQ specifically for their SC biological medication, encompassing a necessity and a concerns scale. The medication possession ratio (MPR) was calculated to assess adherence to the SC biological medication. The BMQ was completed by 321 patients. Between 71.0 and 89.7% of patients agreed/strongly agreed with necessity scale statements, and only 7.2% had low necessity scores. Between 20.0 and 49.8% of patients agreed/strongly agreed with four of five concern scale statements, and 72.3% agreed/strongly agreed with the concern statement regarding long-term medication effects. The percentage with high concerns was 58.9%, and was higher in patients not satisfied with, or with less fulfillment of, tolerability expectations. Non-adherence percentages were, respectively, 13.8 and 13.0% (p = 0.919) in those with high or low necessity, and 16.0 and 10.6% (p = 0.171) in those with high or low concerns. Most patients were categorized as 'ambivalent' (58.5%; high necessity/high concerns) or 'accepting' (36.1%; high necessity/low concerns) of their SC biological medication. The BMQ identified patients' concerns with their SC biological medication. Because patients' concerns could influence non-adherence to medication and future outcomes, physicians should address this issue in the clinic by informing patients and setting clear expectations.

A good understanding of cutaneous nerve entrapment syndromes is important for physicians to provide early and accurate diagnosis and treatment. These syndromes have traditionally been managed with analgesics, antidepressants or antiepileptic medication but this approach is often inadequate and causes frequent adverse medication effects. With early diagnosis and treatment, many nerve entrapment syndromes can be successfully managed with physical, non-pharmacological approaches including stretches, exercises and physiotherapy.

Objective This study was designed to investigate patterns of medication use among drivers using pharmaceutical drugs, the subjective impact of medication use on driving, and knowledge about the effects of medication use on driving. Methods An online survey was administered to a sample of Japanese drivers (n = 1424, age range 21–79 years) to investigate the use pattern of major sedating medications such as cold/sinus drugs, anxiolytics, hypnotics, and antidepressants. The strength of association between variables pertaining to the use of sedating medications and self-reported at-fault crash involvement was explored using a series of multivariate logistic regression models. Results On average, respondents reported using 2.7 sedating medications over the past two years (standard deviation = 1.8; range = 0–11). The pattern of psychotropic medication use was diverse, and the use of multiple psychotropic medications was common. Respondents could be grouped into four subgroups in terms of multiple medication use. Irrespective of the type of medication taken, respondents noticed few adverse side effects of medication on driving and generally did not adhere to driving-related product warnings; some respondents were unaware of important facts such as the exacerbation of the effects of medication effects when combining medications. Multivariate logistic regression analyses showed that the presence of a higher number of sedating agents in the medication taken was positively associated with reporting an at-fault crash in the last two years, having longer driving distance, being a commercial driver, receiving more traffic tickets, and having a higher tendency for rules violations. Conclusions The present study showed that medication use by drivers is diverse and complex, that most drivers are not sufficiently informed of the potentially impairing effects of medication, and that poly-medication use appeared prevalent among those who use psychotropic medications. In line with previous studies, the current study reveals a need for better communication between health experts and patients and for education of all stakeholders. The results also highlighted the need for systematic investigation into cause of crash in light of potential contribution of sedating medication used by the driver, given the low autopsy rate for fatally injured drivers in Japan.

The mainstay of treatment of childhood epilepsy is to administer antiepileptic drugs (AEDs). This article provides an overview of the clinical approach to drug treatment of childhood epilepsy, focusing on general principles of therapy and properties of recently introduced medications. Initiation and cessation of therapy, adverse medication effects, drug interactions, indications for the various AEDs, and off-label use of AEDs are reviewed. The distinct challenges in treatment of epileptic spasms and neonatal seizures are addressed. Finally, ideas for the future of drug treatment of childhood epilepsy are presented, with particular attention to precision medicine.

Treatment responses to methylphenidate by adults with ADHD are generally monitored against DSM-IV/DSM-V symptomatology, rating scales or interviews during reviews.To evaluate the use of single- and dual-dimension processing-speed and efficiency measures to monitor the effects of pharmacological treatment with methylphenidate after a short period off medication.A Quick Test of Cognitive Speed (AQT) monitored the effects of immediate-release methylphenidate in 40 previously diagnosed and medicated adults with ADHD. Processing speed was evaluated with prior prescription medication, without medication after a 2-day period off ADHD medication, and with low-dose (10/20 mg) and high-dose (20/40 mg) methylphenidate hydrochloride (Medikinet IR).Thirty-three participants responded to the experimental treatments. One-way ANOVA with post-hoc analysis (Scheffe) indicated significant main effects for single dimension colour and form and dual-dimension colour-form naming. Post-hoc analysis indicated statistical differences between the no- and high-dose medication conditions for colour and form, measures of perceptual speed. For colour-form naming, a measure of cognitive speed, there was a significant difference between no- and low-dose medication and between no- and high-dose medications, but not between low- and high-dose medications.Results indicated that the AQT tests effectively monitored incremental effects of the methylphenidate dose on processing speed after a 2-day period off medication. Thus, perceptual (colour and form) and cognitive speed (two-dimensional colour-form naming) and processing efficiency (lowered shift costs) increased measurably with high-dose medication. These preliminary findings warrant validation with added measures of associated behavioural and cognitive changes.

Item does not contain fulltext BACKGROUND: Dopaminergic medication adjustments in Parkinson's disease are often solely based on patient reports. However, it is unclear how well patient-based ratings of the levodopa response correlate with clinician-based ratings, and whether this correlation differs between motor symptoms. Here we compare patient-clinician agreement for the effect of levodopa on resting tremor and bradykinesia/rigidity. Furthermore, given patients' reports that tremor is most troublesome during stress, we test for differences in patient-clinician agreement between tremor at rest and stress-induced tremor. METHODS: We included 42 tremulous Parkinson patients, who were clinically rated (using the MDS-UPDRS) in a practically defined OFF-state and after levodopa-benserazide 200/50 mg. Using accelerometry, we quantified the effect of dopaminergic medication and behavioral context (rest vs. cognitive stress) on tremor intensity. Patients rated medication effects on tremor and bradykinesia/rigidity using visual analogue scales. RESULTS: There was only moderate patient-clinician agreement for the effect of levodopa on bradykinesia/rigidity (R2 = 0.18; p < 0.01), and a tendency towards larger agreement for tremor (R2 = 0.44; p < 0.001; difference between correlation coefficients: z = 1.64; p = 0.051). Patient ratings of tremor changes correlated significantly better with accelerometry for tremor during cognitive stress (R2 = 0.35; p < 0.001) vs. tremor at rest (R2 = 0.12; p < 0.05; difference: z = -2.35, p < 0.01). CONCLUSION: The moderate correlations between patient ratings and clinical/accelerometry changes indicate the need for methods to better monitor symptom severity and impairments in daily life, for example wearable sensors. Our findings also suggest that context matters: Parkinson patients' subjective experience of levodopa effectiveness on tremor was largely based on the ability of levodopa to reduce tremor during cognitive stress.

All models addressing the etiology of cognitive abnormality in epilepsy include the iatrogenic effects of antiepileptic drugs (AEDs). This interest sustained through the decades began with bromides and phenobarbital1,2 and continues to the present.3 Critical contributions to this literature have included cognitive results from randomized clinical trials of initial and adjuvant therapy, controlled crossover trials in healthy volunteers, dose ranging studies, and numerous clinical investigations examining the cognitive effects of drug add-on or withdrawal. Further evidence of neuronal effects of AEDs that may affect cognition include reports demonstrating AED influences on brain metabolism,4 brain structure,5 brain neurophysiology,6 and functional activation during cognitive tasks.7,8

Obtaining complete medication histories is imperative to treating patients effectively and avoiding unintended medication consequences. Health care providers (HCPs) receive training and learn skills to help elicit complete medical information, including but not limited to medication use, but the system falls short in some instances (1,2). In these instances, undocumented medication use can complicate patients’ treatment. Examples encompass confounding of the differential diagnosis and unforeseen medication interactions. The potential for unintended medication consequences can be increased by omissions in reporting usage of herbal, homeopathic, or over-the-counter (OTC) treatments. Although warnings about the risks of self-medicating, such as possible variability of medication effects from one person to another, date back for decades, this practice has become increasingly common (3,4). Self-medication through the use of old prescriptions or OTC products has the potential to pose problems, but self-medication via prescription sharing with other individuals—often family members or friends—is especially problematic. This practice can be dangerous because it can remain undetected for long periods of time and may be accompanied by a wide range of effects. Prescription medications are intended to be used under the supervision of licensed HCPs. The sharing of prescription medications among individuals removes pharmacists and other HCPs from the medication use process, resulting in the loss of education and instruction regarding the safe use of medications and increasing the potential for adverse effects (5,6). A survey distributed to patients in community pharmacies in New Zealand showed that, among prescription sharers, about half of prescription borrowers received written instructions with the medication, and about half of prescription lenders gave verbal instructions with the medication (7). That leaves many individuals with no instructions at all, and those who do receive instructions cannot be certain that they have received correct information because the source is not …

Objectives This study aimed to systematically review the pain and flare-up effects of calcium hydroxide (CH) as intracanal medication (ICM) in non-vital mature teeth. Materials and Methods Electronic-databases searching for published and grey literature and manual searching were conducted. Only randomized clinical trials (RCTs) were included comparing CH to other ICMs in non-vital mature teeth. The risk of bias was assessed using the RoB 2.0 Cochrane tool. The main outcomes were pain and flare-up. Qualitative and quantitative analysis, wherever applicable, was performed. The certainty of evidence (CoE) was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results Sixteen articles were included in 6 comparisons at different time points for different outcomes. CH reduced pain risk than no ICM within the 1–14-days interval (p < 0.05) and than triple-antibiotic paste within the first day (p < 0.05) and was similar to corticosteroid/antibiotics combination (p > 0.05). Chlorhexidine (CHX) or CH/CHX, however, reduced pain levels than CH alone (p < 0.05). CH showed higher flare-up risk than CHX (p < 0.05). CoE, however, ranged from very low to moderate. Conclusion Most comparisons for different outcomes are based on very few studies, mostly low-powered, with an overall low CoE. Thus, the available evidence is considered insufficient to either support or refute CH effectiveness or to recommend one ICM over another. Therefore, further well-designed, larger RCTs are required. Trial Registration PROSPERO database Identifier: CRD42016041953

Use of antihypertensives in older adults can be complicated by the potential for undesired effects on comorbidities, adverse effects of the drugs, and overall medication burden. The purpose of this two-part review is to discuss contemporary issues encountered in the management of hypertension in aged individuals, with a particular focus on the individualization of treatment. In part 1, we discuss the evaluation of the aged hypertensive patient and review the clinical trial evidence for treatment benefit of hypertension in the elderly. Elderly patients with suspected hypertension need careful evaluation of their blood pressure, as errors in measurement technique, inaccurate devices, or overreliance on office blood pressure readings may lead to under- or over-treatment, thereby increasing risks of adverse medication effects and/or cardiovascular events. Epidemiologic evidence in older adults suggests a link between low blood pressure and increased mortality. However, key prospective hypertension trials such as HYVET and SPRINT, which were focused in mostly healthy, community-dwelling elderly cohorts, have unequivocally demonstrated benefits of lowering blood pressure in reducing cardiovascular events in the very elderly. Recent evidence also suggests benefit in reducing the risks of cognitive impairment. Hypertension is a major modifiable risk factor and the benefits of treatment in lowering cardiovascular events are realized for most individuals, even at advanced ages.

Continuous monitoring the safe use of medication is an important task in pharmacovigilance. The first-hand experiences of medication effects come from the consumers of the pharmaceuticals. Social media have been considered as a possible alternative data source for gathering consumer-generated information of their experience with medications. Identifying personal experience in social media data is a challenging task in natural language processing. In this study, we investigated a method of predicating personal experience tweets using Google’s Bidirectional Encoder Representations from Transformers (BERT) and neural networks, in which BERT models contextually represented the tweet text. Both pre-trained BERT models and our BERT model trained with 3.2 million unlabeled tweets were examined. Our results show that our trained BERT model performs better than Google’s pre-trained models (p < 0.01). This suggests that domain-specific data may contribute to the BERT model yielding better classification performance in predicting personal experience tweets of medication use.

Assessment of cognitive functioning is an ever-growing field of medicine and pertinent with an aging population. Screening for impairment is often focused on brief performance measures of attention and memory with organic disorders foremost among possible causative diagnoses. However, assessing for nonorganic factors that may contribute to cognitive dysfunction such as poor sleep, mood disorders, and medications is essential in ruling out potentially reversible causes of impairment. This chapter will focus on medications and their impact on cognition. While there are many classes of medications reported to impact cognitive functioning, this chapter will review four common medication types regularly prescribed in a primary care setting (e.g., psychotropic medications, sleep medications, anticholinergics, and pain medications), as well as address issues of polypharmacy.