Treatment of Mood and Depressive Disorders With Complementary and Alternative Medicine: Efficacy Review.

There has been a steady increase in people with symptoms of depression over the past several years (since 2011). The further increase in stress and depression in the early part of the COVID-19 pandemic was accompanied by an increase in unmet mental health needs. Many have turned to complementary and alternative medicine (CAM) therapies such as bright-light therapy, yoga, meditation, and dietary supplements like St. John's wort or folic acid. The reliability of evidence for use of CAM therapies for depression has remained low. There are few randomized controlled trials (RCTs) in the current literature and poor methodology in many of the trials that are available. This state of the science review examines current published guidelines, meta-analyses, systematic reviews, and RCTs regarding use of CAM therapies in the management of depression.

Is it Time to Expand Glucagon-like Peptide-1 Receptor Agonist Use for Weight Loss in Patients Without Diabetes?

The obesity and type 2 diabetes mellitus epidemics demonstrate that simply emphasizing a healthy lifestyle is insufficient. While weight loss medications have historically been considered "cosmetic", glucagon-like peptide-1 receptor agonists (GLP1-RAs) also reduce cardiovascular risk in patients with type 2 diabetes. Therefore, we assessed whether GLP1-RAs warrant use in patients who are overweight (body mass index 27.0-29.9 kg/m2) without weight-related comorbidity. We reviewed trials of available GLP1-RAs with a natural GLP1 backbone given their trend toward cardiovascular benefit and excluded trials requiring concurrent antidiabetic agents associated with weight gain. We assessed 20 phase III trials of GLP1-RAs studied in cardiovascular outcome trials. The GLP1-RAs consistently produced weight loss. Hypoglycemia risk with GLP1-RAs was generally low without other precipitating factors, whereas gastrointestinal adverse effects were common. Dulaglutide 1.5 mg weekly did not produce sufficient weight loss to support its use specifically for weight loss, while data supporting dulaglutide 3.0 or 4.5 mg weekly were limited to a single trial. Weight loss was sufficient with liraglutide 1.8 mg daily in one trial and was consistently sufficient with liraglutide 3.0 mg daily. Oral and injectable semaglutide at both doses consistently produced weight loss, though demonstrated a potential increased risk for retinopathy. Overall, we suggest five GLP1-RAs can be used in the treatment of overweight (body mass index 27.0-29.9 kg/m2 without weight-related comorbidity) with shared decision making to address each medications' key limitation: liraglutide 1.8 mg daily (less demonstrated weight loss), liraglutide 3.0 mg daily (no cardiovascular outcome trial at this dose), and oral and injectable semaglutide at both doses (uncertain retinopathy risk and pending cardiovascular outcome trial of high-dose semaglutide). Use should be limited to patients who fail, refuse, or cannot access lifestyle interventions for weight loss, and should be accompanied by standard restrictions on and monitoring of weight loss medications. We expect additional and earlier use of weight loss therapies to help clinicians curb the obesity and type 2 diabetes epidemics.

Pharmacists interventions using Bluetooth technology and telehealth to improve blood pressure-A pilot study.

OBJECTIVES: To assess patients' knowledge of blood pressure (BP) and their comfort level with using technology, including a Bluetooth-enabled BP device and pharmacist telemonitoring. The secondary objective was to discover if pharmacist interventions improved BP readings. SETTING: The study took place in Pharmacy Plus and the Family Medicine Department at the University of South Florida in Tampa, FL. PRACTICE DESCRIPTION: The pharmacists within Pharmacy Plus and the Family Medicine Department are part of the interdisciplinary team providing care to patients and seeking to achieve optimal patient outcomes. Pharmacy Plus breaks away from the traditional behind-the-counter model using innovative technology to create a personalized experience for patients. PRACTICE INNOVATION: During this pilot study, the patients received a Bluetooth-enabled BP monitor and were asked to obtain their BP readings at least once daily for 6 weeks. The patients' electronic health records automatically captured the BP readings, which were reviewed by the study pharmacists. The patients had an appointment with the pharmacists once weekly via a telehealth platform through which they were counseled on their weekly average BP, BP goals, lifestyle modifications, and proper use of the devices. EVALUATION: The patients completed a prestudy survey assessing their baseline knowledge of BP, comfort level when using technology, and ease in working with pharmacists. Reliability and satisfaction in using the BP device and telehealth communication with pharmacists were also assessed poststudy. RESULTS: Twelve patients enrolled, with 9 completing the study. There was a statistically significant increase in patients' knowledge of BP and an improvement in the recommended lifestyle modifications. In addition, comfort level regarding communication with the pharmacist was statistically significantly improved. The patients responded positively to using the Bluetooth-enabled BP monitor and telehealth for receiving health care services. CONCLUSION: Using Bluetooth-enabled BP monitors that report results in real time into electronic health records, along with pharmacist interventions within a team-based care model, may result in improved BP control and patient outcomes.

Diabetes Group Visits at the University of South Florida Morsani College of Medicine.

IN BRIEF "Quality Improvement Success Stories" are published by the American Diabetes Association in collaboration with the American College of Physicians, Inc., and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes a successful project from the Division of General Internal Medicine at the University of South Florida Morsani College of Medicine, Tampa, to improve A1C, systolic blood pressure, and weight in patients with type 2 diabetes.

EPA-Registered Repellents for Mosquitoes Transmitting Emerging Viral Disease.

In many parts of the United States, mosquitoes were previously nuisance pests. However, they now represent a potential threat in the spread of viral diseases. The Aedes aegypti, Aedes albopictus, and Culex species mosquitoes are endemic to the United States and together may transmit a variety of viral diseases of growing concern, including West Nile virus, chikungunya, dengue fever, and Zika virus. The Centers for Disease Control and Prevention and the Environmental Protection Agency (EPA) recommend N,N-diethyl-meta-toluamide (DEET) as a first-line mosquito repellent, but for patients refusing to use DEET or other conventional repellents, guidance is limited to any EPA-registered product. Therefore, we conducted a systematic review of the literature to identify which EPA-registered personal mosquito repellent provides the best protection from A. aegypti, A. albopictus, and Culex spp. mosquitoes. We abstracted data from 62 published reports of EPA-registered mosquito repellents. The conventional repellent picaridin has the strongest data to support its use as a second-line agent, while IR3535 and oil of lemon eucalyptus are reasonably effective natural products. Citronella, catnip, and 2-undecanone offer limited protection or have limited data. These results can be used by pharmacists and other health care professionals to advise patients on the selection of an EPA-registered mosquito repellent. Regardless of the repellent chosen, it is vital for patients to follow all instructions/precautions in the product labeling to ensure safe and effective use.