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The outcomes of goal-oriented medication reviews for the elderly: current research and future directions. 以目标为导向的老年人用药审查结果:当前研究与未来方向。
IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-01 Epub Date: 2024-09-03 DOI: 10.1080/17512433.2024.2400248
Janet Sultana, Graziella Aquilina, Malak Bashir Lagaa, Nicole Micallef, Janet Mifsud
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引用次数: 0
OPTIMA-ID: development and validation of a medicine optimization tool for older adults with intellectual disability. OPTIMA-ID:开发和验证针对智障老年人的药物优化工具。
IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-01 Epub Date: 2024-08-13 DOI: 10.1080/17512433.2024.2390913
Juliette O'Connell, Ashleigh Gorman, Éilish Burke, Shoumitro Deb, Martin Charles Henman, Philip McCallion, Mary McCarron, Tara Mullally, Niamh Mulryan, Máire O'Dwyer, Cristín Ryan

Background: Older people (i.e. ≥40 years) with intellectual disability have unique medication needs and may experience high levels of potentially inappropriate prescribing. Despite the availability of tools to optimize older adults' prescriptions, there is no comprehensive tool specifically for use in older adults with intellectual disability. We aimed to develop a tool for this purpose: Optimizing Pharmaco-Therapy and Improving Medication for Ageing with Intellectual Disability (OPTIMA-ID).

Research design and methods: A draft tool was developed based on literature review and clinical expertise. Focus groups with healthcare professionals and people with intellectual disability were conducted to refine the tool. The tool was presented electronically to an expert panel for Delphi validation. Median level of agreement and 75th percentile values were used to establish if consensus was reached. Criteria were accepted, rejected, revised or removed to develop the final tool.

Results: Following two Delphi rounds, consensus on the content of OPTIMA-ID was reached for 67 prescribing criteria, 63 of which were agreed upon after Round 1 and a further 4 criteria accepted after Round 2.

Conclusions: OPTIMA-ID contains 67 criteria that can optimize medications for older people with intellectual disability. Its effectiveness, feasibility and impact on patient outcomes need to be established.

背景:智障老年人(即年龄≥40 岁)有独特的用药需求,可能会出现大量潜在的不当处方。尽管目前已有一些优化老年人处方的工具,但还没有专门用于智障老年人的综合工具。我们旨在为此开发一种工具:智障老年人优化药物治疗和改善用药(OPTIMA-ID):研究设计与方法:根据文献综述和临床专业知识开发了工具草案。为完善该工具,与医护人员和智障人士开展了焦点小组讨论。该工具以电子形式提交给专家小组进行德尔菲验证。采用协议中值和第 75 百分位值来确定是否达成共识。对标准进行接受、拒绝、修改或删除,以制定最终工具:经过两轮德尔菲验证,就 67 项处方标准达成了共识,其中 63 项标准在第一轮验证后达成一致,另有 4 项标准在第二轮验证后被接受:结论:OPTIMA-ID 包含 67 项标准,可优化智障老年人的用药。结论:OPTIMA-ID 包含 67 项可优化智障老年人用药的标准,其有效性、可行性和对患者预后的影响有待确定。
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引用次数: 0
The effect of anticholinergic drugs on cognition of patients with Parkinson's disease: a cohort study from the Egyptian population. 抗胆碱能药物对帕金森病患者认知能力的影响:一项来自埃及人群的队列研究。
IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-08-01 Epub Date: 2024-05-30 DOI: 10.1080/17512433.2024.2359955
Sherifa Ahmed Hamed, Ali Farrag El Hadad

Background: Cognitive dysfunction is a non-motor manifestation of Parkinson's disease (PD). We aimed to determine the frequency and patterns of cognitive dysfunction in treated patients with PD and their predictors.

Research design and methods: This study included 80 patients (male = 48; female = 32) and 30 healthy individuals. They underwent neuropsychiatric evaluations. Measurements included Beck's depression inventory - II (BDI-II), mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA).

Results: Patients had mean age of 55.56 ± 9.06 yrs, duration of PD of 4.86 ± 2.71 yrs and Hoehn and Yahr Scoring of 2.19 ± 0.89. They were on levodopa/carbidopa therapy and adjuvant therapy with benztropine mesylate, an anticholinergic drug, (n = 51) or amantadine sulfate, a dopaminergic drug, (n = 29). Sixteen (20%) had moderate depressive symptoms. Mild and moderate cognitive impairments were reported in 38.8% and 28.8% (by MMSE) and 46.3% and 31.3% (by MoCA). Patients had lower global cognitive scoring (p = 0.0001) and scorings of different cognitive functions (naming, attention, language, abstraction, memory and orientation) than controls. Patients treated with benztropine had lower cognition than with amantadine. Correlation analyses showed that lower cognition was only associated with chronic PD and its treatment (p = 0.0001).

Conclusions: Cognitive dysfunction is common with PD (77.5%) particularly with anticholinergic drugs. De-prescription of anticholinergics is recommended for patients with PD.

背景:认知功能障碍是帕金森病(PD)的一种非运动表现:认知功能障碍是帕金森病(PD)的一种非运动表现。我们旨在确定接受治疗的帕金森病患者出现认知功能障碍的频率和模式及其预测因素:本研究包括 80 名患者(男性 48 名;女性 32 名)和 30 名健康人。他们接受了神经精神病学评估。测量项目包括贝克抑郁量表-II(BDI-II)、小型精神状态检查(MMSE)和蒙特利尔认知评估(MoCA):患者平均年龄为(55.56±9.06)岁,帕金森病病程为(4.86±2.71)年,Hoehn 和 Yahr 评分为(2.19±0.89)分。他们接受左旋多巴/卡比多巴治疗,并使用抗胆碱能药物甲磺酸苄托品(51人)或多巴胺能药物硫酸金刚烷胺(29人)辅助治疗。16人(20%)有中度抑郁症状。38.8%和28.8%的患者存在轻度和中度认知障碍(通过MMSE),46.3%和31.3%的患者存在轻度和中度认知障碍(通过MoCA)。与对照组相比,患者的总体认知评分(p = 0.0001)和不同认知功能(命名、注意力、语言、抽象、记忆和定向)的评分均较低。与金刚烷胺相比,接受苯扎托品治疗的患者认知能力更低。相关分析表明,认知能力较低仅与慢性帕金森病及其治疗有关(P = 0.0001):结论:认知功能障碍在帕金森病中很常见(77.5%),尤其是使用抗胆碱能药物时。建议对帕金森病患者停用抗胆碱能药物。
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引用次数: 0
The risk of genito-urinary infections with sodium-glucose cotransporter-2 inhibitors: duration rather than dose matter? 钠-葡萄糖共转运体-2 抑制剂的泌尿生殖系统感染风险:持续时间比剂量更重要?
IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-08-01 Epub Date: 2024-06-13 DOI: 10.1080/17512433.2024.2367106
Wan-Chuan Tsai, Yu-Sen Peng, Hon-Yen Wu
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引用次数: 0
Somatic pharmacogenomics in the treatment prognosis of locally advanced rectal cancer patients: a narrative review of the literature. 局部晚期直肠癌患者治疗预后的体细胞药物基因组学:文献综述。
IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-08-01 Epub Date: 2024-07-24 DOI: 10.1080/17512433.2024.2375449
Noemi Milan, Federico Navarria, Erika Cecchin, Elena De Mattia

Introduction: Standard treatment for patients with locally advanced rectal cancer (LARC) includes neoadjuvant chemoradiotherapy (nCRT) with fluoropyrimidines, followed by surgical excision. The newly introduced therapeutic strategies propose intensified regimens or more conservative approaches based on risk stratification algorithms that currently include clinicoradiological criteria but not molecular variables. How to better stratify patients is a burning clinical question, and pharmacogenomics may prove useful in identifying new genetic markers that could be incorporated into clinical algorithms to personalize nCRT. An emerging area could be the evaluation of somatic mutations as potential genetic markers that correlate with patient prognosis. Tumor mutations in the RAS/BRAF genes, as well as microsatellite instability (MSI) status, are currently used in treatment selection for colorectal cancer (CRC); however, their clinical value in LARC is still unclear.

Area covered: This literature review discusses the relevant findings on the prognostic role of mutations in the key oncogenes RAS, KRAS, BRAF, PIK3CA, SMAD4 and TP53, including MSI status in LARC patients treated with nCRT.

Expert opinion: KRAS proved to be the most promising marker, consistently associated with poorer disease-free survival and overall survival. Therefore, KRAS could be a good candidate for integration into the risk stratification algorithm to develop a personalized treatment.

简介:局部晚期直肠癌(LARC)患者的标准治疗包括使用氟嘧啶类药物的新辅助化放疗(nCRT),然后进行手术切除。新推出的治疗策略根据目前包括临床放射学标准而非分子变量的风险分层算法提出了强化治疗方案或更保守的方法。如何更好地对患者进行分层是一个亟待解决的临床问题,药物基因组学可能有助于确定新的遗传标记,并将其纳入临床算法,从而实现 nCRT 的个性化。一个新兴领域可能是将体细胞突变评估为与患者预后相关的潜在遗传标记。目前,RAS/BRAF 基因中的肿瘤突变以及微卫星不稳定性(MSI)状态已被用于结直肠癌(CRC)的治疗选择;然而,它们在 LARC 中的临床价值仍不明确:本文献综述讨论了主要癌基因RAS、KRAS、BRAF、PIK3CA、SMAD4和TP53突变的预后作用的相关研究结果,包括接受nCRT治疗的LARC患者的MSI状态:事实证明,KRAS是最有希望的标志物,它始终与较差的无病生存率和总生存率相关。因此,KRAS可能是将其纳入风险分层算法以制定个性化治疗的良好候选指标。
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引用次数: 0
Enhancing readability of USFDA patient communications through large language models: a proof-of-concept study. 通过大型语言模型提高 USFDA 患者通信的可读性:概念验证研究。
IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-08-01 Epub Date: 2024-06-04 DOI: 10.1080/17512433.2024.2363840
Kannan Sridharan, Gowri Sivaramakrishnan

Background: The US Food and Drug Administration (USFDA) communicates new drug safety concerns through drug safety communications (DSCs) and medication guides (MGs), which often challenge patients with average reading abilities due to their complexity. This study assesses whether large language models (LLMs) can enhance the readability of these materials.

Methods: We analyzed the latest DSCs and MGs, using ChatGPT 4.0© and Gemini© to simplify them to a sixth-grade reading level. Outputs were evaluated for readability, technical accuracy, and content inclusiveness.

Results: Original materials were difficult to read (DSCs grade level 13, MGs 22). LLMs significantly improved readability, reducing the grade levels to more accessible readings (Single prompt - DSCs: ChatGPT 4.0© 10.1, Gemini© 8; MGs: ChatGPT 4.0© 7.1, Gemini© 6.5. Multiple prompts - DSCs: ChatGPT 4.0© 10.3, Gemini© 7.5; MGs: ChatGPT 4.0© 8, Gemini© 6.8). LLM outputs retained technical accuracy and key messages.

Conclusion: LLMs can significantly simplify complex health-related information, making it more accessible to patients. Future research should extend these findings to other languages and patient groups in real-world settings.

背景:美国食品和药物管理局(USFDA)通过药物安全通讯(DSCs)和用药指南(MGs)来传达新药安全问题,由于其复杂性,这些材料往往对阅读能力一般的患者构成挑战。本研究评估了大语言模型(LLM)能否提高这些材料的可读性:我们使用 ChatGPT 4.0© 和 Gemini© 分析了最新的 DSC 和 MG,将其简化为六年级的阅读水平。对输出结果的可读性、技术准确性和内容包容性进行了评估:结果:原始材料难以阅读(DSCs 年级为 13 级,MGs 为 22 级)。LLMs 大大提高了可读性,将年级降到了更容易阅读的水平(单一提示 - DSCs:ChatGPT 4.0© 10.1,Gemini© 8;MGs:ChatGPT 4.0© 7.1,Gemini© 6.5。多重提示 - DSCs:ChatGPT 4.0© 10.3、Gemini© 7.5;MGs:ChatGPT 4.0© 8、Gemini© 6.8)。LLM 输出保留了技术准确性和关键信息:LLM 可以大大简化复杂的健康相关信息,使患者更容易获得这些信息。未来的研究应将这些发现推广到现实世界中的其他语言和患者群体。
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引用次数: 0
Psoriatic arthritis, biologic therapy experience, body mass index, and onset age of psoriasis were independent factors of secukinumab discontinuation in patients with psoriasis. 银屑病关节炎、生物治疗经验、体重指数和银屑病发病年龄是银屑病患者停用赛库单抗的独立因素。
IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-08-01 Epub Date: 2024-07-12 DOI: 10.1080/17512433.2024.2378762
Neslihan Akdogan, Kerem Balan, Basak Yalici Armagan, Duygu Gulseren, Sibel Dogan

Introduction: Despite the availability of several treatments for psoriasis (PsO), factors influencing the persistence of secukinumab (SEC) therapy remain inadequately understood. This study aimed to identify predictors of SEC persistence in PsO.

Methods: A retrospective analysis was conducted on 109 PsO patients who received SEC treatment at least 1 year. Patients were categorized based on continued or discontinued SEC therapy.

Results: Among the 109 patients, 64 continued SEC treatment while 45 discontinued. Univariate analysis demonstrated that PsA presence and previous biologic therapy use increased the risk of SEC discontinuation 3.56- and 2.33-fold (p = 0.001, %95 CI: 1.66-7.65 and p = 0.032, %95 CI: 1.08-5.04, respectively). Additionally, the risk of SEC discontinuation is 57% higher in patients with a body mass index (BMI) above 26.5 compared to those with a BMI below 26.5 (p = 0.016, %95 CI: 0.22-0.85). Additionally, patients with PsO onset age below 26.5 years were found to have a 2.93-times higher risk of discontinuing SEC compared to those with PsO onset age above 26.5 years (p = 0.004, %95 CI: 1.40-6.13).

Conclusion: PsA presence, previous biologic therapy experience, BMI, and PsO onset age were identified as independent predictors of SEC discontinuation. These findings underscore the importance of personalized treatment strategies for PsO patients receiving SEC therapy.

简介:尽管目前有多种治疗银屑病(PsO)的方法,但影响赛库单抗(SEC)治疗持续性的因素仍未得到充分了解。本研究旨在确定银屑病 SEC 治疗持续性的预测因素:方法:对接受赛可瑞治疗至少 1 年的 109 名 PsO 患者进行了回顾性分析。结果:109 名患者中,64 人继续接受了 SEC 治疗:结果:109 名患者中,64 人继续接受 SEC 治疗,45 人中断治疗。单变量分析表明,PsA 存在和既往使用生物疗法会使 SEC 中止治疗的风险分别增加 3.56 倍和 2.33 倍(p = 0.001,%95 CI:1.66-7.65 和 p = 0.032,%95 CI:1.08-5.04)。此外,与体重指数(BMI)低于 26.5 的患者相比,体重指数(BMI)高于 26.5 的患者停用 SEC 的风险要高出 57%(p = 0.016,%95 CI:0.22-0.85)。此外,与发病年龄高于 26.5 岁的患者相比,发病年龄低于 26.5 岁的患者停用 SEC 的风险高出 2.93 倍(p = 0.004,%95 CI:1.40-6.13):结论:PsA存在、既往生物治疗经验、体重指数和PsO发病年龄被确定为SEC停药的独立预测因素。这些发现强调了为接受 SEC 治疗的 PsO 患者制定个性化治疗策略的重要性。
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引用次数: 0
The impact of pregnancy-related hormonal and physiological changes on antiseizure medications: expert perspective. 与妊娠有关的荷尔蒙和生理变化对抗癫痫药物的影响:专家观点。
IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-08-01 Epub Date: 2024-05-21 DOI: 10.1080/17512433.2024.2356617
Denise Li, Susannah Franco, Page B Pennell

Introduction: Epilepsy is a disorder of recurrent, unprovoked seizures affecting approximately 15 million individuals of childbearing potential worldwide. Patients with epilepsy rely on regular daily therapy with antiseizure medications (ASMs). Furthermore, ASMs are also prescribed for other neuropsychiatric indications (e.g. bipolar disorder, pain, migraines) with over 2% of the pregnancies in the United States involving prenatal exposure to ASMs.

Areas covered: ASM concentrations are affected by hormonal and physiological changes in pregnancy, including increases in renal and hepatic blood flow, decreased protein binding, and changes in enzyme activity. Clearance changes typically reverse within a few weeks after delivery. During pregnancy, many ASMs, such as lamotrigine, levetiracetam, and oxcarbazepine, should have serum concentrations monitored and doses increased to maintain the individualized target range for seizure control. ASMs metabolized via glucuronidation, primarily lamotrigine, undergo marked increases in clearance throughout pregnancy, requiring about 3-fold the pre-pregnancy daily dose by delivery. Postpartum, ASM doses are usually decreased over several weeks to prevent drug toxicity.

Expert opinion: In the future, the development of a physiologically-based pharmacokinetic model for various ASMs may enable empiric dose adjustments in pregnancy without the difficulties of frequent therapeutic drug monitoring.

导言:癫痫是一种无诱因反复发作的疾病,影响着全球约 1500 万育龄人群。癫痫患者需要每天定期服用抗癫痫药物(ASMs)。此外,ASMs 还可用于其他神经精神适应症(如躁郁症、疼痛、偏头痛),美国有超过 2% 的孕妇在产前接触过 ASMs:ASM 的浓度受孕期激素和生理变化的影响,包括肾脏和肝脏血流量增加、蛋白结合力下降以及酶活性变化。清除率的变化通常在分娩后几周内逆转。在妊娠期间,许多 ASMs,如拉莫三嗪、左乙拉西坦和奥卡西平,应监测血清浓度并增加剂量,以维持癫痫发作控制的个体化目标范围。通过葡萄糖醛酸化代谢的 ASM(主要是拉莫三嗪)在整个孕期的清除率会显著增加,到分娩时需要的每日剂量约为孕前的 3 倍。产后,ASM 的剂量通常会在几周内减少,以防止药物中毒:专家意见:未来,针对各种 ASM 开发基于生理学的药代动力学模型可能会使妊娠期经验性剂量调整成为可能,而无需频繁进行治疗药物监测。
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引用次数: 0
Reply to: The risk for genito-urinary infections with sodium-glucose cotransporter-2 inhibitors: duration rather than dose matter? 答复:钠-葡萄糖共转运体-2 抑制剂的泌尿生殖系统感染风险:时间长短比剂量更重要?
IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-08-01 Epub Date: 2024-06-12 DOI: 10.1080/17512433.2024.2367101
Kannan Sridharan, Gowri Sivaramakrishnan
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引用次数: 0
Perspectives on deprescribing in older people with type 2 diabetes and/or cardiovascular conditions: challenges from healthcare provider, patient and caregiver perspective, and interventions to support a proactive approach. 对患有 2 型糖尿病和/或心血管疾病的老年人取消处方的看法:从医疗服务提供者、患者和护理者的角度看所面临的挑战,以及支持积极主动方法的干预措施。
IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-08-01 Epub Date: 2024-08-12 DOI: 10.1080/17512433.2024.2378765
Petra Denig, Peter J C Stuijt

Introduction: For people with type 2 diabetes and/or cardiovascular conditions, deprescribing of glucose-lowering, blood pressure-lowering and/or lipid-lowering medication is recommended when they age, and their health status deteriorates. So far, deprescribing rates of these so-called cardiometabolic medications are low. A review of challenges and interventions addressing these challenges in this population is pertinent.

Areas covered: We first provide an overview of relevant deprescribing recommendations. Next, we review challenges for healthcare providers (HCPs) to deprescribe cardiometabolic medication and provide insight in the patient and caregiver perspective on deprescribing. We summarize findings from research on implementing deprescribing of cardiometabolic medication and reflect on strategies to enhance deprescribing. We have used a combination of methods to search for relevant articles.

Expert opinion: There is a need for rigorous development and evaluation of intervention strategies aimed at proactive deprescribing of cardiometabolic medication. To address challenges at different levels, these should be multifaceted interventions. All stakeholders must become aware of the relevance of deintensifying medication in this population. Education and training for HCPs and patients should support patient-centered communication and shared decision-making. Development of procedures and tools to select eligible patients and conduct targeted medication reviews are important for implementation of deprescribing in routine care.

导言:对于 2 型糖尿病和/或心血管疾病患者来说,当他们年龄增长、健康状况恶化时,建议他们停用降糖、降压和/或降脂药物。迄今为止,这些所谓的心血管代谢药物的停药率很低。对这一人群所面临的挑战和应对这些挑战的干预措施进行回顾很有意义:我们首先概述了相关的取消处方建议。接下来,我们回顾了医疗服务提供者(HCPs)在开具心脏代谢药物处方时所面临的挑战,并从患者和护理人员的角度深入分析了开具处方的问题。我们总结了有关实施心脏代谢药物去处方化的研究结果,并思考了加强去处方化的策略。我们采用了多种方法搜索相关文章:专家观点:有必要严格制定和评估旨在主动取消心脏代谢药物处方的干预策略。为了应对不同层面的挑战,这些干预措施应该是多方面的。所有利益相关者都必须认识到对这一人群减量用药的意义。针对保健医生和患者的教育和培训应支持以患者为中心的沟通和共同决策。开发相关程序和工具以选择符合条件的患者并进行有针对性的药物审查,对于在常规护理中实施减量用药非常重要。
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引用次数: 0
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Expert Review of Clinical Pharmacology
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