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The Drugs (Prices Control) Order of 2013 in India regulated the prices of certain essential and life-saving drugs to ensure their affordability and availability, expecting an increase in sales of those drugs. The authors study the effects of the regulation on sales volumes of each regulated drug using a synthetic control approach with sales data from a comparable country that did not experience a regulatory change. They assess the robustness of the results via multiple empirical approaches to triangulate the findings. Contrary to the order's objectives, they find that sales volumes declined for regulated drugs. Since the order placed restrictions on production levels and on drugs exiting the market, the lowered margins of regulated drugs could have pushed pharmaceutical firms to reduce their marketing expenditures on them. The authors provide evidence of such a reduction using detailing data from a large pharmaceutical firm. The findings illustrate that this shift in detailing adversely affected prescriptions from physicians without formal medical degrees who treat poor and disadvantaged people in India—patients that the order was intended to help the most. A survey the authors conducted shows that these physicians rely on detailing more than medically trained doctors. Taken together, the results provide insights into the strategic actions of firms when faced with regulations, and highlight their unintended consequences. The generalizable nature of the study's findings across a broad set of medications has implications for governmental agencies in terms of the need to account for the entire ecosystem when implementing such regulations. [ABSTRACT FROM AUTHOR]

Moral repair is an important way for firms to heal moral relationships with stakeholders following a transgression. The concept is rooted in recognition theory, which is often used to develop normative perspectives and prescriptions, but the same theory has also propelled a view of moral repair as premised on negotiation between offender and victim(s), which involves the complex social construction of the transgression and the appropriate amends. The tension between normative principles and socioconstructivist implementation begs the question how offending firms should approach moral repair. Addressing this question, we develop a two-level conceptualization of moral repair, distinguishing between procedural and substantive levels of practice, which accommodate normativity and socioconstructivism, respectively. In so doing, we enrich the literature by 1) promoting conceptual clarity, 2) refining understanding of the moral repair process, and 3) suggesting the use of a unified, configurational approach to studying (nonlinear) relations between amends and moral outcomes. [ABSTRACT FROM AUTHOR]

Uveal melanoma (UM), although a rare malignancy, stands as the most prevalent intraocular malignancy in adults. Controversies persist regarding the dose dependency of local control (LC) through radiation therapy. This study sought to elucidate the significance of the prescription dose by employing time-dose-response models for patients with UM receiving photon-based stereotactic radiosurgery (SRS). The analysis included patients with UM treated between 2005 and 2019. All patients underwent single-fraction SRS. Datapoints were separated into 3 dose groups, with Kaplan-Meier analysis performed on each group, from which time-dose-response models for LC were created at 2, 4, and 7 years after SRS using maximum-likelihood fitted logistic models. Outcomes from 594 patients with 594 UMs were used to create time-dose-response models. The prescribed doses and the number of patients were as follows: 17 to 19 Gy (24 patients), 20 Gy (122 patients), 21 Gy (442 patients), and 22 Gy (6 patients). Averaged over all patients and doses, LC rates at 2, 4, and 7 years were 94.4%, 88.2%, and 69.0%, respectively. Time-dose-response models for LC demonstrated a dose-dependent effect, showing 2-year LC rates of more than 90% with 20 Gy and 95% with 22 Gy. For 4 years and a LC of 90%, a dose of approximately 21 Gy was required. After 7 years, the 21 Gy prescription dose was predicted to maintain a LC above 70%, sharply declining to less than 60% LC with 19 Gy and less than 40% with 18 Gy. In contrast to prior findings, the time-dose-response models for UM undergoing photon-based SRS emphasize the critical role of the prescription dose in achieving lasting LC. The dose selection must be carefully balanced against toxicity risks, considering tumor geometry and individual patient characteristics to tailor treatments accordingly. [ABSTRACT FROM AUTHOR]

Purpose Introduction of new medications to health-system formularies is often not accompanied by assessments of their clinical impact on the local patient population. The growing availability of electronic health record (EHR) data and advancements in pharmacoepidemiology methods offer institutions the opportunity to monitor the medication implementation process and assess clinical effectiveness in the local clinical context. In this study, we applied novel causal inference methods to evaluate the effects of a formulary policy introducing tocilizumab therapy for critically ill patients with coronavirus disease 2019 (COVID-19). Methods We conducted a medication use evaluation utilizing EHR data from patients admitted to a large medical center during the 6 months before and after implementation of a formulary policy endorsing the use of tocilizumab for treatment of COVID-19. The impact of tocilizumab on 28-day all-cause mortality was assessed using a difference-in-differences analysis, with ineligible patients serving as a nonequivalent control group, and a matched analysis guided by a target trial emulation framework. Safety endpoints assessed included the incidence of secondary infections and liver enzyme elevations. Our findings were benchmarked against clinical trials, an observational study, and a meta-analysis. Results Following guideline modification, tocilizumab was administered to 69% of eligible patients. This implementation was associated with a 3.1% absolute risk reduction in 28-day mortality (odds ratio, 0.86; number needed to treat to prevent one death, 32) attributable to the inclusion of tocilizumab in the guidelines and an additional 8.6% absolute risk reduction (odds ratio, 0.65; number needed to treat to prevent one death, 12) linked to its administration. These findings were consistent with estimates from published literature, although the effect estimates from the difference-in-differences analysis exhibited imprecision. Conclusion Evaluating formulary management decisions through novel causal inference approaches offers valuable estimates of clinical effectiveness and the potential to optimize the impact of new medications on population outcomes. [ABSTRACT FROM AUTHOR]

Purpose The establishment of a new outpatient pharmacy provided a strategic opportunity to repurpose and convert an existing outpatient pharmacy into a closed-door mail-order pharmacy within a health system. This article describes the steps taken to successfully make this change and evaluates the impact. Summary The mail-order pharmacy conversion project was divided into 3 phases: phase 1 (before conversion) from July through August 2022, phase 2 (conversion) from October through November 2022, and phase 3 (after conversion) from December 2022 through February 2023. Phase 1 included standardizing workflows with standard operating procedure (SOP) development, improving automation, determining staffing ratios, gathering baseline staff engagement data, and identifying primary and secondary outcomes of interest. Phase 2 encompassed SOP implementation and training of mail-order team members. Phase 3 involved evaluating available pharmacy floorspace, marketing mail-order services, and the second distribution of the staff engagement survey. The measured outcomes of this project were total prescription volumes, increase in total revenue, and staff engagement. Data collection was completed in phase 3. Conclusion The existing outpatient pharmacy was successfully converted to a closed-door pharmacy, and the associated prescription volume increased. Developing a strategic action plan to establish SOPs, calculate staffing performance metrics, and identify opportunities for growth and engaging frontline team members were essential to the success of this project. [ABSTRACT FROM AUTHOR]

Aim: To examine the level of adherence to best‐practice guidelines of interprofessional teams with acute care nurse practitioners (ACNPs) compared to interprofessional teams without ACNPs. Design: A retrospective observational study was conducted in 2023. Method: A retrospective cohort was created including 280 patients who underwent a coronary artery bypass graft and/or a valve repair and hospitalised in a cardiac surgery unit of a university affiliated hospital in Québec (Canada) between 1 January 2019 to 31 January 2020. The level of adherence to best‐practice guidelines was measured from a composite score in percentage. The composite score was created from a newly developed tool including 99 items across six categories (patient information, pharmacotherapy, laboratory tests, post‐operative assessment, patient and interprofessional teams' characteristics). Multivariate linear and logistic regression models were computed to examine the effect of interprofessional teams with ACNPs on the level of adherence to best‐practice guidelines. Results: Most of the patients of the cohort were male and underwent a coronary artery bypass graft procedure. Patients under the care of interprofessional teams with ACNP were 1.72 times more likely to reach a level of adherence higher than 80% compared to interprofessional teams without ACNPs and were 2.29 times more likely to be within the highest quartile of the scores for the level of adherence to best‐practice guidelines of the cohort. Impact: This study provides empirical data supporting the benefits of ACNP practice for patients, interprofessional teams and healthcare organisations. Relevance for Practice: Our findings identify the important contributions of interprofessional teams that include ACNPs using a validated instrument, as well as their contribution to the delivery of high quality patient care. Reporting Method: This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies guidelines. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Objectives. To examine drug overdoses in Colombia by type of substance, sex, age, and intent using data from a health surveillance system from 2010 to 2021. Methods. We characterized data by year, type of substance, and sociodemographic variables. We calculated age-adjusted overdose rates by substance type, sex, age groups, and intent. We used Poisson regression models to examine trend differences across sex and age groups. Results. Age-adjusted rates of drug overdoses increased from 8.51 to 40.52 per 100 000 during 2010 to 2021. Men, compared with women, had higher overdose rates for every substance, except for opioids and psychotropics. Drug overdose rates involving cannabis and stimulants increased steadily until 2017 but decreased afterward. Overdose rates involving psychotropic medication increased greatly during 2018 to 2021, mainly because of intentional overdoses in young women. Conclusions. Overdoses involving illegal drugs decreased in recent years in Colombia; however, the continuous increase in intentional psychotropic overdose rates highlights the need for prevention efforts to curb this trend. Health surveillance systems are an important tool that can guide overdose prevention efforts in countries with limited data resources. (Am J Public Health. 2024;114(11):1252–1260. https://doi.org/10.2105/AJPH.2024.307786) [ABSTRACT FROM AUTHOR]

Background: Although substance use rates among adolescents have decreased, drug overdose deaths among adolescents have increased since 2020, driven largely by illegally made fentanyl (IMF). This study explores substance use patterns and characteristics of adolescents who were assessed for substance use disorder (SUD) treatment to inform prevention and response strategies. Methods: A convenience sample of adolescents aged 10–18 years assessed for SUD treatment from September 2017 to December 2021 was analyzed using the Comprehensive Health Assessment for Teens. The percentage of lifetime and past 30-day substance use was examined. Adolescent characteristics (e.g., demographics, history of overdoses or hospital visits due to drug/alcohol use) were analyzed by lifetime substances used. Results: Among 5,377 assessments, most were male (58.7%), aged 16–18 years (50.5%), non-Hispanic White (43.1%), enrolled in school (87.3%), and living with their parent(s) (72.4%). The most commonly reported lifetime substances used were marijuana (68.0%), alcohol (54.2%), and prescription opioid misuse (13.6%). The most common past 30-day substance use combination was alcohol and marijuana (35.6%). The percentage of assessments indicating past-year overdoses or hospital visits due to drug/alcohol use was greatest among those who reported lifetime use of IMF (24.0%), followed by heroin (21.4%) and cocaine (15.3%). Overall, 2.3% reported lifetime IMF use and 0.6% thought IMF was causing them the most problems. Conclusions: Findings inform opportunities to address substance use and increased IMF-involved overdose among adolescents. Continued overdose prevention and response strategies such as evidence-based education campaigns, naloxone distribution and harm reduction efforts, and evidence-based SUD treatment expansion are needed. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to provide prescriptions through a practitioner lens to managers and leaders wishing to cultivate an organizational environment characterized by employees' voluntary open upward communication. Design/methodology/approach: This paper presents a two-step progression to fostering successful voluntary upward communication, framing manager's feedback inquiry as a precursor to enabling employee voice. Rationale is provided for each step based on an extensive review of the management literature. At times, the reviewed research reveals counterintuitive findings that serve to underscore the importance of this article. Findings: Hallmarks of effective organizations include managers who are open to feedback and employees who are comfortable providing it. Specific, actionable and feasible advice is provided for managers to seek feedback more actively and to inculcate a culture of open upward communication. Originality/value: This paper offers guidance that goes beyond the traditional practices adopted by organizations to encourage upward communication, feedback and employee voice. Yet, this guidance is no more difficult to enact than these more common approaches and it is supported by a growing body of research that has yet to be fully translated into lay terms. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to re‐examine the sequence symmetry analysis (SSA) in a mathematical framework to improve the understanding and use of the design. The mathematical properties of the crude, null‐effects, and adjusted sequence ratios (SR) are analyzed in the presence of prescription time‐trends and unmeasured time‐invariant confounding. The theoretical results are illustrated in a simulation study. The crude SR can be interpreted as an estimator of the hazard ratio (HR) of treatment when the allowed time between initiation of the treatment and the outcome drug is small. The HR can easily be estimated flexibly as a function of covariates, such as age and sex, using logistic regression. The crude SR implicitly adjusts for unmeasured time‐invariant confounding, whereas the null‐effects SR, and thereby the adjusted SR, make little sense unless treatment and outcome are strictly independent. The use of the adjusted SR should be abandoned. Another design should be used if it is infeasible to require treatment and outcome sufficiently close. The crude SR can be modeled flexibly with logistic regression to estimate covariate‐dependent HRs or at least to test whether the HR depends on covariates. [ABSTRACT FROM AUTHOR]

Summary Intravenous immunoglobulin (IVIg) is the gold standard treatment for severe cases of immune thrombocytopaenia (ITP). However, its cost, limited duration of efficacy and market supply tension have led French guidelines to reserve IVIg for ITP patients with formal contra‐indications to corticosteroids, with French bleeding score (‘Khellaf score’) > 8, and corticosteroid‐resistant patients either with Khellaf score ≤ 8 or in preparation for an invasive procedure or during pregnancy. We studied the prescribing practices of IVIg for ITP in real‐life conditions and assessed their compliance with French guidelines. A monocentric retrospective study was conducted between 2016 and 2020 among 114 patients hospitalized in our unit, for a total of 208 IVIg treatments. In 37% of cases, the Khellaf score was >8, validating IVIg prescription according to French guidelines. In the remaining cases, reasons noted for use of IVIg included corticosteroid resistance (33.7%), preparation for an invasive procedure (8.5%), context of pregnancy (6.6%) and contra‐indication to corticosteroids (3.3%). After analysis, IVIg prescription was considered valid according to current French guidelines in 84.4% of cases. Non‐compliant IVIg prescription was more frequent in younger patients (p = 0.027). Concomitant anti‐coagulation was also noted as an argument for IVIg prescription outside of the current French guidelines. [ABSTRACT FROM AUTHOR]

It was recently shown that integrating out M2 states on Calabi‐Yau manifolds captures non‐perturbative topological string physics in the free energy. In this note, It has been shown that the resulting expression manifests a certain duality symmetry: the free energy at strong string coupling is equal to the Calabi‐Yau period at weak string coupling. The duality yields the appropriate prescription for completing the integrating out in the ultraviolet. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusions To introduce a novel methodology for subjective refraction based on power vectors with a conventional phoropter.A conventional phoropter was used to measure power vector components of refraction (M, J0 and J45) directly by using the sphere power (for M measurement) and the cylinder power combined with the Jackson cross‐cylinders (for J0 and J45 measurements). Conventional subjective refraction was also performed, and this result was mathematically transformed into power vector notation for comparison purposes. Visual acuities with the conventional prescription and the quasi‐vector‐based prescription were compared.Refractive error from 40 healthy participants was measured by conventional and quasi‐vector‐based subjective refraction. No differences were found between methods for any of the power vector components of refraction (p > 0.21 in all cases). The visual acuity achieved with the prescriptions yielded similar values (p = 0.85).Subjective refraction can be measured directly in power vector notation using a conventional phoropter without any additional adaptation and computation. [ABSTRACT FROM AUTHOR]

The article deals with the differential cost regulation according to § 106 para. 2a sentence 1 SGB V and an arbitration decision of the Federal Arbitration Board, which was challenged by the National Association of Statutory Health Insurance Physicians. The appeal of the clinic is unsuccessful, as the arbitration decision is lawful and the clinic's rights are not violated. It is discussed whether billing without a prescription from a contracted physician is permissible if the patient autonomously rejects inpatient treatment. It is determined that such a regulation violates the law and no separate remuneration is provided for an admission examination. [Extracted from the article]

The article "Prescription of Cannabis Flowers" discusses the requirements for the prescription of cannabis for medical purposes according to the Social Code Book V. It is argued that a justified assessment by the treating physician is necessary to obtain approval. The Federal Social Court has ruled that the coding of a decubitus ulcer must be done as a pressure sore. The court's decision emphasizes the need for a strict interpretation of billing regulations. [Extracted from the article]

Introduction: The use of codeine in children aged < 12 years has been restricted in Japan since July 2017 due to safety concerns. Objective: We aimed to investigate the impacts of two labelling revisions restricting codeine use in children on the trends in its prescriptions in Japan. Methods: Children aged < 12 years (target group) and 12–17 years (control group) registered in the Japanese health insurance claims database between August 2015 and July 2021 were included. We analyzed the level and trend changes in monthly prescriptions of codeine and non-narcotic antitussives (reference) per 100,000 individuals using an interrupted time-series design across there period: the pre-intervention (before the first revision in July 2017), post-intervention (after the second revision in July 2019), and transitional (between the two revisions) periods. Results: There was a significant reduction in codeine prescriptions of 67.5% and 36.6% in the first labelling revision in the target and control groups, respectively. In the target group, a downward trend in the level of codeine prescriptions was observed until the end of the transitional period. After the second labelling revision, the level of codeine prescriptions decreased by approximately 95% compared with the last month of the pre-intervention period. For non-narcotic antitussives, there were no significant changes in the level and trend of prescriptions until the transitional period, but the trend significantly changed to negative after the second labelling revision. Conclusion: Restriction on codeine use in children by the labelling revisions could be effective for reducing codeine prescriptions in patients aged < 12 years. [ABSTRACT FROM AUTHOR]

Introduction: Access to medicines is a critical aspect of healthcare, and health technology assessment (HTA) agencies play a pivotal role in evaluating innovative medicines. Objectives: The objective of this study was to critically review Health Technology Assessment (HTA) recommendations for innovative medicines across the United Kingdom (England, Scotland, Wales and Northern Ireland) following their licensure by the European Medicines Agency (EMA) in 2017. By analysing HTA recommendations, we aimed to understand differences between licensing and reimbursement recommendations and explore variations in access to innovative treatments within the UK. Methods: The study focused on HTA decisions made between 2017 and 2020 in the UK for innovative medicines that were licensed by the European Medicines Agency (EMA) in 2017. Published documents were used for the analysis. The decisions were categorized as 'recommend without restrictions', 'recommend with restrictions', 'not recommended' or 'not assessed'. Results: In 2017, the EMA approved licenses for 56 new innovative medicines. Between 2017 and January 2020, the National Institute for Health and Care Excellence (NICE) in England completed the appraisal of 28 of these medicines. Out of the 28, 11 were 'recommended without restrictions', 15 were 'recommended with restrictions' and 2 were 'not recommended'. The majority of NICE recommendations (21 out of 26, or 81%) were made through managed access agreements. The Scottish Medicines Consortium (SMC) assessed 31 out of the 56 medicines licensed in 2017. Among these 31, 8 were 'recommended without any restriction', 22 were 'recommended with restrictions' and 1 was 'not recommended'. In Wales, the All Wales Medicines Strategy Group (AWMSG) follows NICE guidance and does not review a medicine if NICE is planning to assess it within the next 12 months. In Northern Ireland, HTA guidance from either NICE or SMC is followed, and a decision is adopted shortly after one of them makes its decision. In Northern Ireland, 39 recommendations were adopted from either NICE or SMC, including 10 without restrictions, 21 with restrictions and 8 not recommended decisions. Conclusions: This study sheds light on the complex landscape of medicine licensing and reimbursement in the UK. While licensing approval ensures safety and efficacy, it does not guarantee access to medicines without reimbursement recommendations. Health technology assessment (HTA) bodies play a crucial role in evaluating clinical effectiveness and cost-effectiveness. Our findings reveal variations in HTA adoption across UK countries, emphasizing the importance of timely recommendations. Notably, 'recommendations with restrictions' prevail, often linked to managed access agreements. As we navigate this complex system, optimizing patient care remains paramount. [ABSTRACT FROM AUTHOR]

New technologies regularly bring about profound changes in our daily lives. Romantic relationships are no exception to these transformations. Some philosophers expect the emergence in the near future of love drugs: a theoretically achievable biotechnological intervention that could be designed to strengthen and maintain love in romantic relationships. We investigated laypeople's resistance to the use of such technologies and its sources. Across two studies (Study 1, French and Peruvian university students, N after exclusion = 186; Study 2, Amazon Mechanical Turk sample, N after exclusion = 693, pre-registered), we found that the use of love drugs designed to strengthen and maintain love in romantic relationships are considered as more morally problematic than psychological therapy with the same aim. In Study 2, we show that this last effect is partially due to the fact that the love resulting from the use of love drugs is perceived as less authentic, intense, and durable. We discuss the specific role of authenticity in the relative moral disapproval of love drugs. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether part-year or year-round uninsurance is associated with reduced likelihood of using prescription contraception methods rather than using nonprescription methods or using no contraceptive methods. Methods: We identified nonpregnant and sexually active female respondents participating in the National Longitudinal Survey of Youth, 1997 cohort between 2007 and 2019. At each interview, we classified the contraceptive method used most frequently as prescription, nonprescription, or none, and used mixed-effects multinomial logistic regression to predict contraceptive method based on health insurance coverage over the past year (classified as continuous private, continuous public, part-year uninsured, or year-round uninsured). Results: Our sample included 3,738 respondents and 18,678 observations (person-years). In the most recent interview, 35% of respondents used prescription contraception, 16% used nonprescription methods only, and 49% used no method. On multivariable analysis using all available years of data, respondents with part-year uninsurance were 20% less likely to use prescription rather than nonprescription methods, as compared to respondents with continuous private insurance (95% confidence interval: −31%, −6%; p = 0.007), but did not differ on the likelihood of using prescription methods rather than no method. Conclusions: Part-year uninsurance was associated with lower use of prescription contraceptive methods rather than nonprescription methods when compared with continuous private insurance coverage. Use of prescription contraceptives was lowest among people with year-round uninsurance. Policy efforts ensuring continuous insurance coverage with greater flexibility of eligibility and enrollment periods may promote greater access to prescription contraceptives. [ABSTRACT FROM AUTHOR]

Rationale Aims and objectives Method Results Conclusion Antibiotic prescription, its nature and its duration are a very common decision‐making situation in primary care practice. Clinical practice guidelines (CPGs) are regularly emitted by various organisations on this topic.Our goal is to run a quality appraisal of the current French guidelines, for the most common primary care infectious pathologies.We collected all primary care CPGs that are currently prevailing in France through a systematic review of the french website Antibioclic®. For each of these guidelines, a quality assessment was run by 3 independent reviewers, by means of the Appraisal of Guidelines for REsearch & Evaluation II instrument. The main outcome was a ‘reliability score’, defined as the sum of the scores in domains ‘rigour of development’ and ‘editorial independence’. To be considered ‘reliable’, the CPG had to reach a 60% threshold in these two domains. Secondary outcomes were as follows: global quality score of CPGs, number and ratio of CPGs for which a systematic review has been conducted during its conception.Over the 43 CPGs that have been assessed, none reached the 60%‐threshold as to the reliability score. Only one CPG (2.33%) gets an over‐60% quality assessment in the domain of rigour of development (D3), whereas three CPGs (6.98%) reach this threshold in the domain of editorial independence (D6). One CPG (2.33%) met the quality threshold of 60% as to overall assessment. Rigour of development and editorial independence are the domains that obtained the lowest average score, respectively, 11% and 21%. Overall assessment received an average score of 29%. A systematic review of the literature was mentioned for 10 CPGs (23.26%).There is a lack of quality in the development process of the current French guidelines in primary care infectiology. This process should be reconsidered, with higher insistence as to its quality. [ABSTRACT FROM AUTHOR]

Background: Migraine is a debilitating neurological disorder that presents significant management challenges, resulting in underdiagnosis and inappropriate treatments, leaving patients at risk of medication overuse (MO). MO contributes to disease progression and the development of medication overuse headache (MOH). Predicting which migraine patients are at risk of MO/MOH is crucial for effective management. Thus, this systematic review aims to review and critique available prediction models for MO/MOH in migraine patients. Methods: A systematic search was conducted using Embase, Scopus, Medline/PubMed, ACM Digital Library, and IEEE databases from inception to April 22, 2024. The risk of bias was assessed using the prediction model risk of bias assessment tool. Results: Out of 1,579 articles, six studies with nine models met the inclusion criteria. Three studies developed new prediction models, while the remaining validated existing scores. Most studies utilized cross-sectional and prospective data collection in specific headache settings and migraine types. The models included up to 53 predictors, with sample sizes from 17 to 1,419 participants. Traditional statistical models (logistic regression and least absolute shrinkage and selection operator regression) were used in two studies, while one utilized a machine learning (ML) technique (support vector machines). Receiver operating characteristic analysis was employed to validate existing scores. The area under the receiver operating characteristic (AUROC) for the ML model (0.83) outperformed the traditional statistical model (0.62) in internal validation. The AUROCs ranged from 0.84 to 0.85 for the validation of existing scores. Common predictors included age and gender; genetic data and questionnaire evaluations were also included. All studies demonstrated a high risk of bias in model construction and high concerns regarding applicability to participants. Conclusion: This review identified promising results for MO/MOH prediction models in migraine patients, although the field remains limited. Future research should incorporate important risk factors, assess discrimination and calibration, and perform external validation. Further studies with robust designs, appropriate settings, high-quality and quantity data, and rigorous methodologies are necessary to advance this field. [ABSTRACT FROM AUTHOR]

Background: Ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), is the most frequent medication to be involved in hypersensitivity drug reactions (HDRs). Other analgesic/anti-inflammatory drugs in the arylpropionic group are also relevant, albeit to a lesser extent. Ibuprofen is widely consumed by people of all ages, both on medical prescription and over the counter; moreover, it is an organic contaminant of surface waters and foods. While numerous drugs cause HDR, ibuprofen's underlying mechanisms are more intricate and involve both specific immunological and non-immunological mediated reactions. Summary: we concentrate on immediate responses, including urticaria with or without angioedema, anaphylaxis, and angioedema, classifying reactions according to whether they are caused by single or multiple NSAIDs and based on the mechanisms at play. Both groups may experience anaphylaxis, defined as an immediate, severe systemic reaction involving at least two organs, though the frequency and severity can vary. Following this classification, more clinical manifestations can be identified. Diagnosis is partly based on a detailed clinical history, including information about ibuprofen and/or other arylpropionic derivatives involved, the interval between drug intake and symptoms onset, clinical manifestations, number of episodes, and the patient's tolerance or response to other medications – mainly non-chemically related NSAID – both before and after reactions to ibuprofen and/or other arylpropionic drugs. A drug provocation test is frequently necessary to make a diagnosis. Key Message: Because ibuprofen is the most widely prescribed NSAID, it is reasonable to assume its role as the leading cause of HDR will only become more important. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Naloxone is lifesaving in the event of an opioid overdose but is underutilized in adolescents. Youth-serving clinicians can play a role in expanding naloxone access by offering it to all youth at risk for opioid-involved overdose, including by prescription. Understanding naloxone dispensing trends to youth can inform efforts to expand its use. METHODS: We used IQVIA National Prescription Audit Patient Insights data, which contains prescriptions dispensed from ~48 900 retail pharmacies, representing 93% of all prescriptions from all payers in the United States. Cross-sectional analyses were used to describe naloxone dispensing trends among youth ages 10 to 19 years over time and by patient sex, out-ofpocket cost, prescriber specialty, and payer. RESULTS: From 2017 to 2022, 59 077 prescriptions for naloxone were dispensed to youth ages 10 to 19. Dispensing rates increased 669%, from 6.6 to 50.9 prescriptions per 100 000 adolescents, with increases each year. Dispensing varied by specialty and sex. Pediatricians accounted for an increasing proportion of prescriptions dispensed with a 6-year increase of 991%. Seventy-four percent of prescriptions were paid through commercial insurance. Although most prescriptions dispensed had low to 0 cost-sharing, 20% had out-of-pocket costs exceeding $25, and over 6% had out-of-pocket costs exceeding $75. CONCLUSIONS: Pediatricians and other youth-serving clinicians can play an important role in expanding access to naloxone and harm reduction information by prescribing naloxone to all youth who are at risk for overdose. Clinician prescribing of naloxone can augment community distribution and over-the-counter access by making naloxone more widely available at all touchpoints with the health care system. [ABSTRACT FROM AUTHOR]

Ketamine is a versatile anesthetic that has been widely used off-label to treat a variety of indications. Esketamine, a derivative of ketamine, is FDA-approved to treat treatment-resistant depression. This report compares statewide prescription ketamine and esketamine trends. Using PDMP data from 2017–2023, prescription and prescriber characteristics, and patient demographics were compared between esketamine and ketamine prescriptions. During this time, ketamine prescriptions, patients, and providers rose 55.8%, 30.6%, and 2.8% since 2017. Esketamine prescriptions increased 1289.4% since 2019. In 2023, ketamine prescriptions were primarily in powder form (98.7%) and paid for out-of-pocket (83.9%), whereas esketamine prescriptions were primarily paid for by insurance (80.2%). The proportion of ketamine prescribed in RI but dispensed out-of-state have increased 22% since 2022 (18% of total dispensations). As more people seek treatment for mental health disorders, ketamine and esketamine prescriptions continue to rise. Understanding ketamine and esketamine use can help mitigate associated adverse events. [ABSTRACT FROM AUTHOR]

Background: Australia introduced a prescription only policy for e‐cigarettes in 2011 to prevent uptake among youth while allowing smokers to access e‐cigarettes for cessation. This is one of the restrictive forms of regulation for e‐cigarettes recommended by the World Health Organisation. Aims: To assess whether the policy has prevented e‐cigarette youth uptake and facilitated smokers' access to e‐cigarettes for cessation; and to examine a proposed toughening of the policy. Methods: An analysis of survey and administrative data on e‐cigarette use and smoking and a critical analysis of the contents of submissions to parliamentary inquiries into the policy. Results: E‐cigarette use among youth and young adults has increased steeply since 2016 but very few of these products have been obtained through the prescription system, because medical authorities discourage their use. A policy change in 2021 to increase the prescription of e‐cigarettes has not reduced e‐cigarette use among youth and only marginally increased rates of prescribing. Australian policy makers have nonetheless tightened the prescription system by banning any use of e‐cigarettes unless prescribed by a doctor and dispensed by a pharmacist. Implications: Australia's tightened prescription policy for e‐cigarettes may reduce adolescent vaping but at the risk of reducing smokers' access to e‐cigarettes and increasing the size of the illicit market for combustible cigarettes and e‐cigarettes. A more effective policy would allow vapes to be sold as consumer products by licensed tobacconists under regulations that require prior product approval, plain packaging, bans on their promotion and enforced age restrictions on purchases. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to determine the proportion of Australians dispensed psychotropic medications between 2013 and 2022 according to their age. Methods: Services Australia provided a de-identified 10% random Pharmaceutical Benefits Scheme sample that allowed us to determine, for each year, the proportion of Australians dispensed at least one script for antipsychotics, antidepressants, anxiolytics, or hypnotics. The classification of medications followed Anatomical Therapeutic Chemical coding. Participants were stratified into 10-year age groups from 0–9 to ⩾90 years, and sex was coded as male/female. We retrieved population numbers from the Australian Bureau of Statistics. Results: The number of records per year ranged from 1,540,520 to 1,746,402, and 54.10% were for females. A greater proportion of older adults, particularly those aged ⩾70 years, were dispensed antipsychotics, antidepressants, anxiolytics and hypnotics than any other age group. The proportion of people who dispensed antipsychotics, anxiolytics and hypnotics declined between 2013 and 2022 but increased for antidepressants, most markedly for adolescents and young adults. Females were more frequently dispensed antidepressants, anxiolytics and hypnotics than males, but males were more frequently dispensed antipsychotics than females, albeit not in later life. Conclusion: Older age groups and females are the most frequent recipients of psychotropic medications dispensed in Australia. [ABSTRACT FROM AUTHOR]

Ketamine is a restricted and regulated medication in Australia and New Zealand, which has implications when considering treatment for patients with treatment-resistant depression and a history of illicit drug use, abuse or dependence. Regulations governing prescription of ketamine for treatment-resistant depression vary between jurisdictions in Australia and New Zealand, though most restrict use in those with drug dependence. There is substantial variation in definitions of drug dependence used in each jurisdiction, and between the legal and clinical definitions, with the latter specified in the current International Classification of Diseases, Eleventh Revision and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. This paper reviews the literature assessing the risk of ketamine misuse and dependence in patients with a history of illicit drug use, abuse or dependence and presents recommendations for psychiatrists who prescribe ketamine in such patients with treatment-resistant depression. [ABSTRACT FROM AUTHOR]

Background & Objective: Objective Structured Practical Examination (OSPE) has gained popularity as an objective assessment tool. Traditional assessment methods such as video and semester practical examinations are better suited to assessing the cognitive domain in pharmacology. The competency-based medical education curriculum has shifted to the psychomotor and attitude communication domains (hands-on demonstration on manikins, criticism of prescription and medical literature, hands-on demonstration on manikins, computer-assisted learning), and assessing these domains calls for more objective methods of assessment, such as the OSPE. This study aimed to design and implement the OSPE as an assessment tool for practical pharmacology for Phase II MBBS students. We also evaluated the perception, acceptability, and usefulness of OSPE for the students and the faculty. Material & Methods: The faculty was sensitized. Group discussions with the head of the department and faculty were held regarding the content of the OSPE stations and the design, planning, implementation, and feasibility checks. The OSPE was scheduled to be held at the upcoming formative examination with a set of 8 OSPE stations and 2 rest stations. The OSPE stations were set up in the department and were initially piloted by faculty. The OSPE was carried out in the formative examination of Phase II students. Feedback questionnaires for both students and faculty members were prepared and validated prior to administration. Results: Of the ninety-eight students in the batch, 96 participated. The average OSPE score obtained by the students was 22.23 ± 5.74 (the total OSPE score was 35). Ninety-six percent of the students enjoyed the OSPE, 99% of whom were satisfied (Likert scale 3-5). All the faculty agreed that the OSPE was unbiased and structured, although it required more effort, and manpower and preparation were time consuming. Conclusion: The key to a successful OSPE is careful planning. A well-designed OSPE can drive learning and have a positive impact on education. [ABSTRACT FROM AUTHOR]

Purpose: Undergraduate medical education (UGME) has to prepare students to do safety-critical work (notably, to prescribe) immediately after qualifying. Despite hospitals depending on them, medical graduates consistently report feeling unprepared to prescribe and they sometimes harm patients. Research clarifying how to prepare students better could improve healthcare safety. Our aim was to explore how students experienced preparing for one of their commonest prescribing tasks: intravenous fluid therapy (IVFT). Methods: Complexity assumptions guided the research, which used a qualitative methodology oriented towards hermeneutic phenomenology. The study design was an uncontrolled and unplanned complex intervention: judicial review of the iatrogenic death of five children due to hyponatraemia in our region had resulted in the recommendation that students' education in 'the implementation of important clinical guidelines' relevant to fluid and electrolyte balance should be intensified. An opportunity sample of 40 final-year medical students drew and gave audio-recorded commentaries on rich pictures. We completed two template analyses: one of participants' transcribed commentaries on the pictures and one using a novel heuristic to analyse the pictures themselves. We then reconciled the two analyses into a single template. Results: There were four themes: affects, teaching and learning, contradictions, and the curriculum as a journey. To explore interconnections between themes, we chose the picture best exemplifying each of the four themes and interpreted the curriculum journey depicted in each of them. These interpretations were grounded in each participant's picture, verbal account of the picture, and the aggregate findings of the template analysis. Participants' experiences were influenced by the situated complexity of IVFT. Layered on top of that, contradictions, overlaps, and gaps within the curriculum introduced extraneous complexity. Confusion and apprehension resulted. Conclusions: After spending five years preparing to prescribe IVFT, participants felt unprepared to do so. We conclude that intensive teaching had not achieved its avowed goal of improving students' preparedness for safe practice. Merton's seminal work on the 'unanticipated consequences of purposive social action' suggests that intensive teaching may even have contributed to their unpreparedness. [ABSTRACT FROM AUTHOR]

Objective: To determine the safety and proof of concept of a parcel-guided, repetitive Transcranial Magnetic Stimulation (rTMS) in patients who develop a heterogeneous array of symptoms, known collectively as post-concussive syndrome (PCS), following traumatic brain injury (TBI). Methods: We performed a retrospective review of off-label, individualized, parcel-guided rTMS in 19 patients from December 2020 to May 2023. Patients had at least one instance of mild, moderate, or severe TBI and developed symptoms not present prior to injury. rTMS targets were identified based on machine learning connectomic software using functional connectivity anomaly matrices compared to healthy controls. EuroQol (EQ-5D), as a measurement of quality of life, and additional questionnaires dependent on individual's symptoms were submitted prior to, after, and during follow-up from rTMS. Results: Nineteen patients showed improvement in EQ-5D and Rivermead Post Concussion Symptoms Questionnaires − 3 after treatment and follow-up. For nine patients who developed depression, five (55%) attained response and remission based on the Beck Depression Inventory after treatment. Eight of ten patients with anxiety had a clinically significant reduction in Generalized Anxiety Disorder-7 scores during follow-up. Conclusion: Parcel-guided rTMS is safe and may be effective in reducing PCS symptoms following TBI and should incite further controlled studies. [ABSTRACT FROM AUTHOR]

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy and Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433. [ABSTRACT FROM AUTHOR]

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433. [ABSTRACT FROM AUTHOR]

Background: Age is a major risk factor for atherosclerotic cardiovascular disease (CVD) and death, but there has been a debate about benefit-risk of statin treatment in the elderly with limited evidence on benefits for primary prevention, while there is strong evidence for its use in secondary prevention. Aim: The aim of this study was to provide an overview of statin utilization in primary and secondary prevention for patients 75–84 years and ≥ 85 years in the Swedish capital Region Stockholm in 2019. Methods: This is a cross-sectional study based on the regional healthcare database VAL containing all diagnoses and dispensed prescription drugs for all 174,950 inhabitants ≥ 75 years old in the Stockholm Region. Prevalence and incidence were analyzed by sex, age, cardiovascular risk, substance, and the intensity of treatment. Results: A total of 35% of all individuals above the age of 75 in the region were treated with statins in 2019. The overall incidence in this age group was 31 patients per 1000 inhabitants. Men, individuals 75–84 compared to ≥ 85 years of age, and those with higher cardiovascular risk were treated to a greater extent. Simvastatin was used primarily by prevalent users and atorvastatin by incident users. The majority was treated with moderate-intensity dosages and fewer women received high intensity treatment. Conclusions: Statins are widely prescribed in the elderly. Physicians seem to consider individual cardiovascular risk when deciding to initiate statin treatment for elderly patients, but here may still be some undertreatment among high-risk patients (especially women and elderly 85 + years) and some overtreatment among patients with low-risk for CVD. [ABSTRACT FROM AUTHOR]

Objectives. To examine trends in overdose deaths by intent and drug category to better understand the recent decrease in overdose suicides amid the overdose epidemic. Methods. We examined trends in rates of overdose deaths by intent (unintentional, suicide, or undetermined) across 9 drug categories from 1999 to 2022 using US National Vital Statistics System mortality data. Results. Unintentional overdoses involving synthetic opioids, polydrug toxicity involving synthetic opioids, psychostimulants, and cocaine increased exponentially with annual percentage changes ranging from 15.0% to 104.9% during 2010 to 2022. The death rates also increased for suicides involving these drugs, especially for psychostimulants (annual percentage change = 12.9% for 2010–2022; P <.001). However, these drugs accounted for relatively small percentages of overdose suicides. The leading drug categories among suicides were antidepressants, prescription opioids, and benzodiazepines, though these deaths have decreased or leveled off in recent years. Conclusions. Different drugs commonly involved in suicides and unintentional overdoses may contribute to their divergent trends. Public Health Implications. Amid the overdose epidemic, safe storage of medications remains a crucial strategy to prevent overdose suicides. The large increases in suicides involving psychostimulants warrant monitoring. (Am J Public Health. 2024;114(10):1081–1085. https://doi.org/10.2105/AJPH.2024.307745) [ABSTRACT FROM AUTHOR]

The gap between morphological knowledge and urban planning is a major problem. The absent or insufficient morphological components of most planning instruments, like municipal plans, seem to reduce planning ability to define adequate rules for urban form transformation. This paper suggests that an integrated methodology for Morphological Analysis and Prescription (MAP), which benefits from the convergence of key complementary methods—morphological regionalization, typological process, and configurational analysis—can be a powerful tool to support planning practice, enabling a structural and comprehensive understanding of urban form dynamics. The Amial area, in Oporto, Portugal, is the setting for comparing the morphological analysis and proposals of MAP and the Oporto municipal master plan (Plano Diretor Municipal), and empirically examining the robustness of MAP. [ABSTRACT FROM AUTHOR]

Context: Modern medicine aims to ensure a world in which all people experience a good end of life as an integral part of their life journey. A good end-of-life experience means dying with dignity and receiving the best healthcare based on scientific evidence. Objective: This study aims to reach a consensus about the contents of a comprehensive instrument based on the 10/40 Model of the International Collaborative for the Best Care for the Dying Person for evaluating inpatients facing imminent death in Portuguese internal medicine wards and a proposal for anticipatory medication for symptom control in inpatient and home care settings. Methods: We employed the Delphi method and conducted various rounds of questionnaire administration to 23 Portuguese internists competent in palliative medicine. Data were obtained in July and September of 2022. Results: Consensus was reached among the expert panel on the diagnostic, initial assessment, monitoring, and after-death care items of the tool, with minor adjustments to wording or content. However, it was not possible to reach a consensus on most of the proposals presented for anticipatory medication for symptomatic control. Conclusion: We present the consensus about the contents of a comprehensive instrument for evaluating inpatients facing imminent death in Portuguese internal medicine wards. Best practices in this setting were defined from the point of view of internists with expertise in palliative care. However, the best pharmacological practices still require further reviews of the literature and consensus. [ABSTRACT FROM AUTHOR]

Deborah Robertson provides an overview of recently published articles that may be of interest to non-medical prescribers. Should you wish to look at any of the papers in more detail, a full reference is provided [ABSTRACT FROM AUTHOR]

A completed research-action project on Climate change adaptation at the regional level (Memphremagog, Québec, Canada) is revisited here, which requires first to briefly recall what is the CCA program, and the project's context, goals, and characteristics. The aim of the paper is to clarify issues of co-construction in dialogue, implementing a way to analytically distinguish phases of co-construction at the level of the research team's effort along the project, by following important dialogue episodes. Stemming out of this dialogue analysis, another contribution of this work is to propose a better picture of the internal relationship between three important components of the normative dimension of such projects: pursued values, processual values, and the prescriptions that were required to actualize these values. [ABSTRACT FROM AUTHOR]

Background: Research has indicated that sexual minorities have higher prevalence rates for ATOD use and suicide ideation and behavior compared to heterosexual youth. Yet, most studies to date have combined gay, lesbian, and bisexuals into one category. This study sought to assess the uniqueness of bisexuality to assess the risk of ATOD use and suicide ideation and behavior among bisexual high school students. Methods: Data for this study were derived from the 2019 Centers for Disease Control's Youth Risk Behavior Survey (YRBS). Chi-square analysis was conducted to determine the prevalence of ATOD use and suicide ideation and behavior. Logistic regression was then used to estimate the association between ATOD use and suicide ideation and behavior among bisexual adolescents. Results: This study found that ever use an electronic vape product, non-medical use of prescription drugs, and current alcohol and marijuana use were significant predictors for suicide ideation and behavior. Conclusions: Based on our results, we believe that it is important to address the relationship of substance use as a risk factor for suicide and ideation and behavior of bisexual adolescents, as bisexual adolescents may need more emotional support as they come to understand their sexual identity. [ABSTRACT FROM AUTHOR]

We present trace , an almost time-reversible hybrid integrator for the planetary N -body problem. Like hybrid symplectic integrators, trace can resolve close encounters between particles while retaining many of the accuracy and speed advantages of a fixed time-step symplectic method such the Wisdom–Holman map. trace switches methods time-reversibly during close encounters following the prescription of Hernandez & Dehnen. In this paper we describe the derivation and implementation of trace and study its performance for a variety of astrophysical systems. In all our test cases, trace is at least as accurate and fast as the hybrid symplectic integrator mercurius. In many cases, trace 's performance is vastly superior to that of mercurius. In test cases with planet–planet close encounters, trace is as accurate as mecurius with a 12× speed-up. If close encounters with the central star are considered, trace achieves good error performance while mercurius fails to give qualitatively correct results. In ensemble tests of violent scattering systems, trace matches the high-accuracy IAS15 while providing a 15× speed-up. In large N systems simulating lunar accretion, trace qualitatively gives the same results as ias15 but at a 41× speed-up. We also discuss some cases such as von Zeipel–Lidov–Kozai cycles where hybrid integrators perform poorly and provide some guidance on which integrator to use for which system. trace is freely available within the rebound package. [ABSTRACT FROM AUTHOR]

Three‐dimensional printing (3DP) has emerged as a game‐changing technology in the pharmaceutical industry, providing novel formulation development in the pharmaceutical sector as a whole, which improved patients' individualized therapy. The pediatric population is among the key targets for individualized therapy. Children are a diverse group that includes neonates, infants, and toddlers, each with unique physiological characteristics. Treatment adherence has a significant impact on safe and effective pharmacotherapy in the pediatric population. Improvement of therapeutic dosage forms that provide for the special demands of the pediatric population is a significant challenge for the pharmaceutical industry. Scientists have actively explored 3DP, a quick prototype manufacturing method that has emerged in recent years from many occupations due to its benefits of modest operation, excellent reproducibility, and vast adaptability. This review illuminates the most widely used 3DP technology and its application in the development of pediatric‐friendly drug formulations. This 3DP technology allows optimization of pediatric dosage regimens and cases that require individualized treatment, such as geriatrics, renal impairment, liver impairment, critically ill, pregnancy populations, and drugs with nonlinear pharmacokinetics. The fast evolution of 3DP expertise, in addition to the introduction of pharmaceutical inks, has enormous promise for patient dosage form customization. [ABSTRACT FROM AUTHOR]

Background: The interrelation between infections, subjective cognitive decline (SCD), and dementia development is recognized, but not fully understood. This study explored the combined effect of specific infections and SCD on the risk of dementia. Objectives: To assess the influence of Helicobacter pylori, herpes simplex virus, varicella-zoster virus, and human papillomavirus on dementia risk in individuals with varying cognitive statuses, especially focusing on those with and without SCD. Methods: A cohort of 1,100,540 participants aged 66 years from the Korean National Health Insurance Service was divided into cognitively preserved (CP, n = 825,405) and SCD (n = 275,135) groups. This study analyzed the effects of single, dual, and triple infections on the risk of overall dementia, Alzheimer's disease (AD), and vascular dementia (VaD) using incidence rates and hazard ratios. Results: The SCD group consistently showed a doubled risk of dementia, particularly AD, regardless of the number of infections. In the initial data, both the presence and number of infections, especially in the CP group, were associated with an increased dementia incidence and risk; however, this correlation disappeared after adjusting for covariates, hinting at a possible protective effect. Conclusion: Our findings emphasize that, while SCD is a steadfast risk factor for dementia, the role of infections is layered, subject to various influences, and requires more comprehensive exploration to fully understand their impact on dementia development. [ABSTRACT FROM AUTHOR]

Background: Awareness and uptake of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) remains low among Black/African American cisgender women, partly due to low self-reported PrEP knowledge and comfort among primary care providers. Ensuring providers are trained on PrEP is crucial, as increased PrEP knowledge is associated with higher rates of PrEP prescription. Objective: We aimed to develop a PrEP training for providers to improve their self-efficacy in discussing and prescribing PrEP for Black women, with the ultimate goal of increasing PrEP awareness and utilization among Black women. Design: In this qualitative study, we conducted focus groups with medical providers at three federally qualified health centers in the Southern and Midwestern United States to identify themes informing the development of a provider PrEP training. Methods: Providers were asked for input on content/design of PrEP training. Transcripts underwent rapid qualitative analysis using the Stanford Lightning Report Method. Themes were identified and presented under the domains of the Consolidated Framework for Implementation Research. Results: Ten providers completed four focus groups. Themes included the individual characteristics of providers (low comfort initiating PrEP discussions, particularly among White providers) and the outer setting of client attitudes (perceptions of potential provider bias/racism, varying levels of concern about HIV acquisition). Opportunities were identified to maximize the benefit of training design (e.g., developing case scenarios to enhance providers' cultural competency with Black women and PrEP knowledge). Conclusion: This comprehensive PrEP training features both didactic material and interactive role-plays to equip providers with the clinical knowledge for prescribing PrEP while building their competency discussing PrEP with Black women. This training is particularly important for providers who have racial or gender discordance with Black women and express lower comfort discussing PrEP with these clients. Provider training could lead to minimizing racial- and gender-based inequities in PrEP use. Plain language summary: Increasing the use of pre-exposure prophylaxis (PrEP) among Black women: a study to improve provider knowledge through PrEP training Why was the study done? Use of pre-exposure prophylaxis (PrEP), a medication that can prevent the transmission of human immunodeficiency virus (HIV), is low among Black/African American women. Part of the reason why is because primary care providers (PCPs) report lower knowledge about PrEP and lower comfort talking about PrEP with clients. Making sure PCPs are trained on PrEP could help increase PrEP use among Black women. What did the researchers do? The research team held focus groups, during which they asked medical providers at federally qualified health centers (FQHCs) in the Southern and Midwestern United States questions about their experiences with discussing PrEP and what information should be included in a training about PrEP for providers to make sure the training would be helpful for them. What did the researchers find? A total of ten providers completed four focus groups. Important points mentioned in the focus groups included low comfort among providers when bringing up PrEP to clients, especially among White providers, as well as different levels of concern about HIV and feelings of potential provider bias/racism among clients. These points helped the researchers design a PrEP training that addresses providers' needs (such as creating case scenarios that help providers practice discussing PrEP with Black women and answering common questions about PrEP). What do the findings mean? A PrEP training for providers should have both information about prescribing PrEP and interactive role-plays to build providers' PrEP knowledge while improving their confidence and skill in talking about PrEP with Black women. This training is particularly important for providers who are a different race or gender than Black women and express lower rates of comfort discussing PrEP with these clients. Provider training could eventually lead to higher PrEP use among Black women. [ABSTRACT FROM AUTHOR]

Background: Postoperative pain delays ambulation, extends hospital stay, reduces the probability of recovery, and increases risk of long-term functional impairment. Pain management in hip fractured patients poses a challenge to the healthcare teams. Older adults are more vulnerable to opioid-associated side effect and it is primordial to minimize their exposure to opioids. Acetaminophen is associated with reduced opioid use so we need to focus on acetaminophen use in first-line analgesia. Methods: We conducted a controlled before/after study to assess the ability of an audit and feedback (A&F) intervention built with nurses to improve the quality of perioperative pain management in older patients hospitalized for hip fracture in an orthogeriatric unit (experimental group) versus a conventional orthopedic unit (no A&F intervention). The primary endpoint was the percentage of patients who received 3 g/day of acetaminophen during the three postoperative days, before and after the A&F intervention. Secondary endpoints included nurses' adherence to medical prescriptions, clinical data associated with patients and finally factors associated with intervention. The significative level was set at 0.05 for statistical analysis. Results: We studied data from 397 patients (mean age 89 years, 75% female). During the postoperative period, 16% of patients from the experimental group received 3 g/day of acetaminophen before the A&F intervention; the percentage reached 60% after the intervention. The likelihood of receiving 3 g/day of acetaminophen during the postoperative period and adhering to the medical prescription of acetaminophen were significantly increased in the experimental group as compared with the control group. The patient's functional status at discharge (assessed by Activities of Daily Living scores) was significantly better and the length of hospital stay significantly reduced after the A&F intervention. Conclusion: Our controlled before/after study showed that an A&F intervention significantly improved perioperative pain management in older adults hospitalized for hip fracture. Involving teams in continuous education programs appears crucial to improve the quality of pain management and ensure nurses' adherence to medical prescriptions. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to assess antibiotic prescribing and use patterns at the Department of Surgery, Korle Bu Teaching Hospital. Design: A cross-sectional study design was employed in this study. Setting: The study was conducted at the Department of Surgery, Korle Bu Teaching Hospital. Participants: Forty-two prescribers out of 63 (67%) at the Department of Surgery responded to questionnaires. Over the study period, prescriptions and medical records of 1715 patients from the general surgery, neurosurgery, and urology units were reviewed. Main Outcome Measures: Percentage of prescriptions with antibiotics, percentage of prescribers using guidelines for antibiotic prescriptions, and percentage using culture and sensitivity to inform antibiotic prescriptions. Results: Of the 1715 prescriptions assessed, 75% (1294/1715) were from inpatients, and 45% (772/1715) included an antibiotic. Ciprofloxacin and metronidazole constituted 54% of antibiotic prescriptions from general surgery. Amoxicillin/ clavulanic acid and ceftriaxone constituted 64.7% of antibiotic prescriptions from neurosurgery, and ceftriaxone and ciprofloxacin made up 37.7% of antibiotic prescriptions from urology. Microbiology testing was done for only 14.5% (9/62) of inpatients who received antibiotics for treatment. The choice of antibiotics was influenced mainly by doctors' previous experience (37/42, 88.1%). Conclusion: Antibiotics are widely used. About half of all prescriptions had antibiotics, with ciprofloxacin and metronidazole constituting more than half of antibiotic prescriptions from general surgery. Doctors mainly based their antibiotic prescriptions on previous experience and occasionally on microbiological investigations. [ABSTRACT FROM AUTHOR]

We study how the number of degrees of freedom in Weyl conformal gravity runs with the energy scale from the UV fixed point. To this end we employ two approaches. First, we utilize the Fradkin–Tseytlin prescription for the number of degrees of freedom and demonstrate that the one-loop result is highly dependent on the selected background. We then employ the counting methodology based on the a- and c-function, which are typically used to characterize the trace anomaly of conformal field theories in four dimensions. We compute these in the enhanced one-loop approximation and demonstrate that the degrees of freedom decrease monotonically from six degrees in the UV regime. This behavior is independent of the backgrounds considered. Further salient issues, such as the connection between the Fradkin–Tseytlin prescription and counting based on the a- and c-function, or the applicability of both methods in Einstein's gravity, are also addressed. [ABSTRACT FROM AUTHOR]

The resummation of large thermal corrections to the effective potential is mandatory for the accurate prediction of phase transitions. We discuss the accuracy of different prescriptions to perform this resummation at the one- and two-loop level and point out conceptual issues that appear when using a high-temperature expansion at the two-loop level. Moreover, we show how a particular prescription called partial dressing, which does not rely on a high-temperature expansion, consistently avoids these issues. We introduce a novel technique to apply this resummation method to the case of multiple mixing fields. Our approach significantly extends the range of applicability of the partial dressing prescription, making it suitable for phenomenological studies of beyond the Standard Model extensions of the Higgs sector. [ABSTRACT FROM AUTHOR]

Background: Drug duplication (DD), the use of two identical drugs simultaneously, is a medication error increasing the risk of adverse drug events. We describe the trends and implicated drugs in potential DD in older adults in Sweden from 2006 to 2021. Methods: We conducted a register-based, repeated cross-sectional study of all older adults (aged ≥65 years) dispensed drugs at a community pharmacy in 2006–2021. DD was defined as a ≥30-day overlap of two dispensations of drugs with the same 5th level (chemical substance) Anatomical Therapeutic Chemical (ATC) classification, but with different brand names, within a 3-month period each year. Results: Among Swedish older adults with ordinary prescriptions (i.e. multidose excluded; n ≈ 1,200,000–1,600,000 per year), the prevalence of potential DD increased from 5.2% to 10.6% in 65- to 79-year-olds and from 7.0% to 11.7% in those aged ≥80 years. The drug groups (ATC level 3; pharmacological subgroup) most frequently implicated in DD in 2006 were β-blocking agents, angiotensin-converting enzyme (ACE) inhibitors, and calcium channel blockers, and in 2021 Vitamin B12 and folic acid, β-blocking agents and angiotensin II receptor blockers. Conclusions: DD represents a common but unnecessary and potentially hazardous medication error. Our results indicate that during the last two decades, the prevalence has almost doubled in older adults with ordinary prescriptions, reaching 11% in 2021. More national efforts are needed to revert this trend, including a nationally available complete drug list for all patients, and prescriber support to detect DD. [ABSTRACT FROM AUTHOR]

As youth with intellectual and developmental disabilities (IDD) are transitioning from the school systems and special education supports, many of them are moving into the adult service system (e.g., Vocational Rehabilitation, Home and Community‐Based Services). Thus, in addition to adolescence being a source of many psychological and behavioral needs, the change in service systems often leads to uncertainty and anxiety. Psychotropic medications tend to be used to treat challenging behavior and psychological conditions (e.g., depression, anxiety, psychosis). This study used National Core Indicators‐In‐Person Survey 2020–2021 data to explore the prevalence of psychotropic medication use among two groups of people with IDD: disability service users of transition age (18–25 years) and disability service users of adult age (26–45 years) and the role of residential settings (where one lives) as related to psychotropic medication use. The results indicated that adults (aged 26–45 years) are more likely to be prescribed psychotropic medications. This appears to be driven by the larger number of transition‐aged adults who still live with family, where prescription rates are much lower. Psychotropic drug use is an important issue due to its potential to lead to unintended negative consequences that affect health, social inclusion, and self‐determination if not carefully and effectively administered. [ABSTRACT FROM AUTHOR]