Frailty in clinical drug trials: Frailty assessments, subgroup analyses and outcomes.

With population ageing, drug trials are increasingly turning their attention to including older, frailer people. This review aimed to provide an overview of how frailty was assessed in published studies related to clinical pharmacological trials, and on the interaction of frailty on the efficacy of the treatments. We searched MEDLINE, EMBASE and Cochrane for clinical drug trials in older people. A total of 4031 abstracts were screened and 17 relevant studies were included in this review. We summarized the findings of these 17 trials into five main clinical areas: cardiovascular (eight studies), cognition (one study), vaccination (two studies), cancer (four studies) and other (two studies). Frailty was assessed retrospectively in most of the studies. Frailty was treated as an ordinal variable (with different levels of frailty) or binary variable (frail/non-frail) using cut-offs in some studies, and as a continuous in some other studies. The effect of frailty on the treatment efficacy was not consistent among the studies. While several trials, such as the Action in Diabetes and Vascular Disease-Preterax and Diamicron Modified Release Controlled Evaluation trials, the Systolic Blood Pressure Intervention Trial and the Aspirin in Reducing Events in the Elderly trial, showed some reduced effects of the treatment in frail patients, most of the trials showed that the benefits of the treatment are not affected by frailty. Some trials even showed that the benefits of the treatment were more significant in frailer patients (the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure and the Dapagliflozin Evaluation to Improve the Lives of Patients with Preserved Ejection Fraction Heart Failure trials). The results of this review suggest that routine measurement of frailty in participants in clinical drug trials would improve our knowledge of the effect of treatment in the frail and identify those who have more or least to gain from treatment.

Multi-metallic Layered Catalysts for Stable Electrochemical CO2 Reduction to Formate and Formic Acid.

Electrochemical CO2 reduction (ECR) to value-added products such as formate/formic acid is a promising approach for CO2 mitigation. Practical ECR requires long-term stability at industrially relevant reduction rates, which is challenging due to the rapid degradation of most catalysts at high current densities. Herein, we report the development of a bismuth (Bi) gas diffusion electrode on a polytetrafluoroethylene-based electrically conductive silver (Ag) substrate (Ag@Bi), which exhibits high Faradaic efficiency (FE) for formate of over 90 % in 1 M KOH and 1 M KHCO3 electrolytes. The catalyst also shows high selectivity of formic acid above 85 % in 1 M NaCl catholyte, which has a bulk pH of 2-3 during ECR, at current densities up to 300 mA cm-2. In 1 M KHCO3 condition, Ag@Bi maintains formate FE above 90 % for at least 500 hours at the current density of 100 mA cm-2. We found that the Ag@Bi catalyst degrades over time due to the leaching of Bi in the NaCl catholyte. To overcome this challenge, we deposited a layer of Ag nanoparticles on the surface of Ag@Bi to form a multi-layer Ag@Bi/Ag catalyst. This designed catalyst exhibits 300 hours of stability with FE for formic acid ≥70 % at 100 mA cm-2. Our work establishes a new strategy for achieving the operational longevity of ECR under wide pH conditions, which is critical for practical applications.

Multimorbidity and Blood Pressure Control in Patients Attending Primary Care in Canada.

BACKGROUND: There has been conflicting evidence on the association between multimorbidity and blood pressure (BP) control. This study aimed to investigate this associations in people with hypertension attending primary care in Canada, and to assess whether individual long-term conditions are associated with BP control. METHODS: This was a cross-sectional study in people with hypertension attending primary care in Toronto between January 1, 2017 and December 31, 2019. Uncontrolled BP was defined as systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg. A list of 11 a priori selected chronic conditions was used to define multimorbidity. Multimorbidity was defined as having ≥1 long-term condition in addition to hypertension. Logistic regression models were used to estimate the association between multimorbidity (or individual long-term conditions) with uncontrolled BP. RESULTS: A total of 67 385 patients with hypertension were included. They had a mean age of 70, 53.1% were female, 80.6% had multimorbidity, and 35.7% had uncontrolled BP. Patients with multimorbidity had lower odds of uncontrolled BP than those without multimorbidity (adjusted OR = 0.72, 95% CI 0.68-0.76). Among the long-term conditions, diabetes (aOR = 0.73, 95%CI 0.70-0.77), heart failure (aOR = 0.81, 95%CI 0.73-0.91), ischemic heart disease (aOR = 0.74, 95%CI 0.69-0.79), schizophrenia (aOR = 0.79, 95%CI 0.65-0.97), depression/anxiety (aOR = 0.91, 95%CI 0.86-0.95), dementia (aOR = 0.87, 95%CI 0.80-0.95), and osteoarthritis (aOR = 0.89, 95%CI 0.85-0.93) were associated with a lower likelihood of uncontrolled BP. CONCLUSION: We found that multimorbidity was associated with better BP control. Several conditions were associated with better control, including diabetes, heart failure, ischemic heart disease, schizophrenia, depression/anxiety, dementia, and osteoarthritis.

Healthcare in Vietnam: Harnessing Artificial Intelligence and Robotics to Improve Patient Care Outcomes.

Healthcare in Vietnam is increasingly utilizing artificial intelligence (AI) and robotics to enhance patient care outcomes. The Vietnamese healthcare sector recognizes the potential of AI and is actively exploring its applications in research and clinical practice. AI technologies, such as text mining and machine learning, can be employed to analyze medical data and improve decision-making processes. Robotics, on the other hand, can support various healthcare tasks, including elderly care, rehabilitation, and surgical interventions. Robotic surgery, specifically, is an innovative form of minimally invasive surgery that aims to improve surgical outcomes and enhance the patient experience. The implementation of AI in emergency and trauma settings is still in its early stages, but there is a growing interest in and recognition of its potential benefits. However, there are challenges that need to be addressed, such as the need for appropriate research and training programs to support the adoption and integration of AI in healthcare. Despite these challenges, healthcare professionals in Vietnam are optimistic about the potential of AI to improve acute care surgery and are open to embracing new digital technologies. The use of AI and robotics in healthcare aligns with the broader goal of improving healthcare systems in low- and middle-income countries, including Vietnam, through technological advancements. Overall, AI can play an important role in assisting prognosis and predictive analysis by integrating vast amounts of data. Moreover, the integration of AI and robotics in healthcare in Vietnam has the potential to enhance patient care outcomes, improve decision-making processes, and support healthcare professionals in their practice.

Lower Energy Excitation of Water Soluble Near-Infrared Emitting Mixed-Ligand Metallacrowns.

By combining advantages of two series of lanthanide(III)/zinc(II) metallacrowns (MCs) assembled using pyrazine- (pyzHA2- ) and quinoxaline- (quinoHA2- ) hydroximate building blocks ligands, we created here water-soluble mixed-ligand MCs with extended absorption to the visible range. The YbIII analogue demonstrated improved photophysical properties in the near-infrared (NIR) range in cell culture media, facilitating its application for NIR optical imaging in living HeLa cells.

On the Physical Layer Security of Federated Learning Based IoMT Networks.

Internet of Medical Things (IoMT) connects different medical devices, health sensors and hospital records to data platforms using wireless communications. Federated Learning (FL) is an emerging collaborative learning technique that can be beneficial for IoMT due to reduced communication overhead and enhanced security. This paper provides an overview of different architectures used in FL and potential approaches for FL based IoMT. We also discuss how Physical Layer Security (PLS) can be used for efficient privacy preservation of data in FL based IoMT. We highlight the recent work in this area and major research challenges related to PLS assisted FL in IoMT. We also provide a case study demonstrating that clustering of IoMT devices (such that a single device in each cluster acts as a cluster head) enhances the secrecy rate of the FL based IoMT network as compared to its non-clustered counterpart. Finally, we also discuss future opportunities and open research questions related to PLS assisted FL in IoMT.

Anti-ultraviolet, antibacterial, and biofilm eradication activities against Cutibacterium acnes of melanins and melanin derivatives from Daedaleopsis tricolor and Fomes fomentarius.

Fomes fomentarius and Daedaleopsis tricolor produced significant amounts of water-insoluble melanins, and our previous study successfully enhanced their water solubility by arginine modification. This research aimed to investigate the anti-ultraviolet, antibacterial, and biofilm eradication activities of both the melanins and arginine-modified melanin (melanin derivatives) from these two fungi against an acne-causing bacterium (Cutibacterium acnes). Apart from these, the cytotoxicity of the melanins and melanin derivatives on human skin cells was also evaluated. Melanin derivatives of both two fungi showed significantly higher antibacterial and biofilm eradication activities compared with their original forms. Specifically, the MIC50 values of the melanin derivatives (1,000 µg/mL) are the same as those of erythromycin. Regarding biofilm eradication capacity, the MBEC50 value of D. tricolor melanin derivative (250 µg/mL) was just half of both erythromycin and F. fomentarius melanin derivative. However, it required a 2-fold higher concentration of melanin derivatives than erythromycin to inhibit 90% of the bacterial population and eradicate 90% of their biofilm. Regarding anti-ultraviolet activity, blending melanins or melanin derivatives with a moisturizer/sunscreen enhanced their UV light absorption and the sun protection factor (SPF) values. In addition, melanins showed better effects than their derivatives, and those of D. tricolor were better than F. fomentarius. Remarkably, adding D. tricolor melanin (10%) to a Nivea pure cream could turn this cream into a broad-spectrum sunscreen, with its SPF value and critical wavelength increasing from 7.74 and 338.67 to 14.02 and 377.0, respectively. In addition, adding melanin or a melanin derivative of D. tricolor to an Olay sunscreen enhanced the SPF and the critical wavelength of the sunscreen from 17.25 and 371.67 to 23.82 and 374 and 23.38 and 372, respectively. Notably, melanins and melanin derivatives showed no toxicity in human fibroblasts. The obtained data suggest that arginine modification significantly enhanced the antibacterial and biofilm eradication activities of melanins from D. tricolor and F. fomentarius. However, this is not the case when it comes to their anti-ultraviolet activities. In addition, melanin and melanin derivatives from D. tricolor are potential candidates for anti-acne sunscreen products and are worth further investigation.

A Cascaded Mutliresolution Ensemble Deep Learning Framework for Large Scale Alzheimer's Disease Detection using Brain MRIs.

Alzheimer's is progressive and irreversible type of dementia, which causes degeneration and death of cells and their connections in the brain. AD worsens over time and greatly impacts patients' life and affects their important mental functions, including thinking, the ability to carry on a conversation, and judgment and response to environment. Clinically, there is no single test to effectively diagnose Alzheimer disease. However, computed tomography (CT) and magnetic resonance imaging (MRI) scans can be used to help in AD diagnosis by observing critical changes in the size of different brain areas, typically parietal and temporal lobes areas. In this work, an integrative mulitresolutional ensemble deep learning-based framework is proposed to achieve better predictive performance for the diagnosis of Alzheimer disease. Unlike ResNet, DenseNet and their variants proposed pipeline utilizes PartialNet in a hierarchical design tailored to AD detection using brain MRIs. The advantage of the proposed analysis system is that PartialNet diversified the depth and deep supervision. Additionally, it also incorporates the properties of identity mappings which makes it powerful in better learning due to feature reuse. Besides, the proposed ensemble PartialNet is better in vanishing gradient, diminishing forward-flow with low number of parameters and better training time in comparison to its counter network. The proposed analysis pipeline has been tested and evaluated on benchmark ADNI dataset collected from 379 subjects patients. Quantitative validation of the obtained results documented our framework's capability, outperforming state-of-the-art learning approaches for both multi-and binary-class AD detection.

Identification of a Novel Renal Metastasis Associated CpG-Based DNA Methylation Signature (RMAMS).

Approximately 21% of patients with renal cell cancer (RCC) present with synchronous metastatic disease at the time of diagnosis, and metachronous metastatic disease occurs in 20-50% of cases within 5 years. Recent advances in adjuvant treatment of aggressive RCC following surgery suggest that biomarker-based prediction of risk for distant metastasis could improve patient selection. Biometrical analysis of TCGA-KIRC data identified candidate loci in the NK6 homeobox 2 gene (NKX6-2) that are hypermethylated in primary metastatic RCC. Analyses of NKX6-2 DNA methylation in three gene regions including a total of 16 CpG sites in 154 tumor-adjacent normal tissue, 189 RCC, and 194 metastatic tissue samples from 95 metastasized RCC patients revealed highly significant tumor-specific, primary metastatic-specific, and metastatic tissue-specific hypermethylation of NKX6-2. Combined CpG site methylation data for NKX6-2 and metastasis-associated genes (INA, NHLH2, and THBS4) demonstrated similarity between metastatic tissues and metastatic primary RCC tissues. The random forest method and evaluation of an unknown test cohort of tissues using receiver operator characteristic curve analysis revealed that metastatic tissues can be differentiated by a median area under the curve of 0.86 (p = 1.7 × 10-8-7.5 × 10-3) in 1000 random runs. Analysis of variable importance demonstrated an above median contribution for decision-making of at least one CpG site in each of the genes, suggesting superior informativity for sites annotated to NHLH2 and NKX6-2. Thus, DNA methylation of NKX6-2 is associated with the metastatic state of RCC tissues and contributes to a four-gene-based statistical predictor of tumoral and metastatic renal tissues.

Catalyst Regeneration via Chemical Oxidation Enables Long-Term Electrochemical Carbon Dioxide Reduction.

Electrochemical CO2 reduction (ECR) with industrially relevant current densities, high product selectivity, and long-term stability has been a long-sought goal. Unfortunately, copper (Cu) catalysts for producing valuable multicarbon (C2+) products undergo structural and morphological changes under ECR conditions, especially at high current densities, resulting in a rapid decrease in product selectivity. Herein, we report a catalyst regeneration strategy, one that employs an electrolysis method comprising alternating "on" and "off" operating regimes, to increase the operating stability of a Cu catalyst. We find that it increases operating lifetime many times, maintaining ethylene selectivity ≥40% for at least 200 h of electrolysis in neutral pH media at a current density of 150 mA cm-2 using a flow cell. We also demonstrate ECR to ethylene at a current density of 1 A cm-2 with ethylene selectivity ≥40% using a three-dimensional Cu gas diffusion electrode, finding that this system under these conditions is rendered stable for greater than 36 h. This work illustrates that Cu-based catalysts, once they have entered into the state conventionally considered to possess degraded catalytic activity, may be recovered to deliver high C2+ selectivity. We present evidence that the combination of short periods of electrolysis, which minimizes the morphological changes during "on" segments, with the progressive chemical oxidation of Cu atoms on the catalyst surface during "off" segments, united with the added effects of washing the accumulated salt and decreasing the catholyte temperature prolong together the catalyst's operating lifetime.

Appendicular Lean Mass and Frailty among Geriatric Outpatients.

The objective of this observational study was to examine the association between appendicular lean mass and frailty in adults aged 60 years and older. This study was conducted in the Outpatient Department of the National Geriatric Hospital in Hanoi, Vietnam. Appendicular lean mass (kg) was assessed by using Dual energy X-ray absorptiometry scans. Frailty was defined according to Fried's frailty criteria. A total of 560 outpatients were included in the study, with a mean age of 70 years. The prevalence of frailty was 12.0%. Frail patients had significantly lower appendicular lean mass compared with non-frail outpatients (9.6 ± 2.0 kg vs. 11.7 ± 3.1 kg, p<0.001). On multivariable logistic regression models, higher appendicular lean mass was associated with significantly reduced odds for frailty (adjusted OR = 0.74, 95%CI 0.59 - 0.93). These findings suggest that the assessment of appendicular lean mass should be considered in older patients attending outpatient geriatric clinics.

Coordinating Health Care With Artificial Intelligence-Supported Technology for Patients With Atrial Fibrillation: Protocol for a Randomized Controlled Trial.

BACKGROUND: Atrial fibrillation (AF) is an increasingly common chronic health condition for which integrated care that is multidisciplinary and patient-centric is recommended yet challenging to implement. OBJECTIVE: The aim of Coordinating Health Care With Artificial Intelligence-Supported Technology in AF is to evaluate the feasibility and potential efficacy of a digital intervention (AF-Support) comprising preprogrammed automated telephone calls (artificial intelligence conversational technology), SMS text messages, and emails, as well as an educational website, to support patients with AF in self-managing their condition and coordinate primary and secondary care follow-up. METHODS: Coordinating Health Care With Artificial Intelligence-Supported Technology in AF is a 6-month randomized controlled trial of adult patients with AF (n=385), who will be allocated in a ratio of 4:1 to AF-Support or usual care, with postintervention semistructured interviews. The primary outcome is AF-related quality of life, and the secondary outcomes include cardiovascular risk factors, outcomes, and health care use. The 4:1 allocation design enables a detailed examination of the feasibility, uptake, and process of the implementation of AF-Support. Participants with new or ongoing AF will be recruited from hospitals and specialist-led clinics in Sydney, New South Wales, Australia. AF-Support has been co-designed with clinicians, researchers, information technologists, and patients. Automated telephone calls will occur 7 times, with the first call triggered to commence 24 to 48 hours after enrollment. Calls follow a standard flow but are customized to vary depending on patients' responses. Calls assess AF symptoms, and participants' responses will trigger different system responses based on prespecified protocols, including the identification of red flags requiring escalation. Randomization will be performed electronically, and allocation concealment will be ensured. Because of the nature of this trial, only outcome assessors and data analysts will be blinded. For the primary outcome, groups will be compared using an analysis of covariance adjusted for corresponding baseline values. Randomized trial data analysis will be performed according to the intention-to-treat principle, and qualitative data will be thematically analyzed. RESULTS: Ethics approval was granted by the Western Sydney Local Health District Human Ethics Research Committee, and recruitment started in December 2020. As of December 2021, a total of 103 patients had been recruited. CONCLUSIONS: This study will address the gap in knowledge with respect to the role of postdischarge digital care models for supporting patients with AF. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12621000174886; https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12621000174886. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/34470.

Redemptive Resource Sharing and Allocation Scheme for Internet of Things-Assisted Smart Healthcare Systems.

Internet of Things assisted healthcare services grants reliable clinical diagnosis and analysis by exploiting heterogeneous communication and infrastructure elements. Communication is enabled through point-to-point or cluster-to-point between the users and the diagnosis center. In this process, the complication is the resource sharing and diagnosis swiftness invalidating multiple resources. IoT's open and ubiquitous nature results in proactive resource sharing, resulting in delayed transmissions. This manuscript introduces the Redemptive Resource Sharing and Allocation (R2SA) scheme to address this issue. The available health data is accumulated on a first-come-first-serve basis, and the transmitting infrastructure is selected. In this process, the data-to-capacity of the available infrastructure is identified for non-redemptive resource allocation. The extremity of the capacity and unavailability of the resource is then analyzed for parallel processing and allocation. Therefore, the data accumulation and exchange rely on concurrent sharing and resource allocation processes, deferring a better accumulation ratio. The concurrent redemptive selection and sharing reduces transmission delay, improves resource allocation, and reduces transmission complexity. The entire process is managed for transfer learning, data-to-capacity validation, and concurrent recommendation. The first validation knowledge base remains the same/shared for different data accumulation and sharing intervals.

Tuning the photophysical properties of lanthanide(iii)/zinc(ii) 'encapsulated sandwich' metallacrowns emitting in the near-infrared range.

A family of Zn16Ln(HA)16 metallacrowns (MCs; Ln = YbIII, ErIII, and NdIII; HA = picoline- (picHA2-), pyrazine- (pyzHA2-), and quinaldine- (quinHA2-) hydroximates) with an 'encapsulated sandwich' structure possesses outstanding luminescence properties in the near-infrared (NIR) and suitability for cell imaging. Here, to decipher which parameters affect their functional and photophysical properties and how the nature of the hydroximate ligands can allow their fine tuning, we have completed this Zn16Ln(HA)16 family by synthesizing MCs with two new ligands, naphthyridine- (napHA2-) and quinoxaline- (quinoHA2-) hydroximates. Zn16Ln(napHA)16 and Zn16Ln(quinoHA)16 exhibit absorption bands extended into the visible range and efficiently sensitize the NIR emissions of YbIII, ErIII, and NdIII upon excitation up to 630 nm. The energies of the lowest singlet (S1), triplet (T1) and intra-ligand charge transfer (ILCT) states have been determined. LnIII-centered total (Q L Ln) and intrinsic (Q Ln Ln) quantum yields, sensitization efficiencies (η sens), observed (τ obs) and radiative (τ rad) luminescence lifetimes have been recorded and analyzed in the solid state and in CH3OH and CD3OD solutions for all Zn16Ln(HA)16. We found that, within the Zn16Ln(HA)16 family, τ rad values are not constant for a particular LnIII. The close in energy positions of T1 and ILCT states in Zn16Ln(picHA)16 and Zn16Ln(quinHA)16 are preferred for the sensitization of LnIII NIR emission and η sens values reach 100% for NdIII. Finally, the highest values of Q L Ln are observed for Zn16Ln(quinHA)16 in the solid state or in CD3OD solutions. With these data at hand, we are now capable of creating MCs with desired properties suitable for NIR optical imaging.

Patient-Led Mass Screening for Atrial Fibrillation in the Older Population Using Handheld Electrocardiographic Devices Integrated With a Clinician-Coordinated Remote Central Monitoring System: Protocol for a Randomized Controlled Trial and Process Evaluation.

BACKGROUND: Atrial fibrillation (AF) is common in older people and increases the risk of stroke. The feasibility and effectiveness of the implementation of a patient-led AF screening program for older people are unknown. OBJECTIVE: This study aims to examine the feasibility and effectiveness of an AF screening program comprising patient-led monitoring of single-lead electrocardiograms (ECGs) with clinician-coordinated central monitoring to diagnose AF among community-dwelling people aged ≥75 years in Australia. METHODS: This is a nationwide randomized controlled implementation trial conducted via the internet and remotely among 200 community-dwelling adults aged ≥75 years with no known AF. Randomization will be performed in a 1:1 allocation ratio for the intervention versus control. Intervention group participants will be enrolled in the monitoring program at randomization. They will receive a handheld single-lead ECG device and training on the self-recording of ECGs on weekdays and submit their ECGs via their smartphones. The control group participants will receive usual care from their general practitioners for the initial 6 months and then commence the 6-month monitoring program. The ECGs will be reviewed centrally by trained personnel. Participants and their general practitioners will be notified of AF and other clinically significant ECG abnormalities. RESULTS: This study will establish the feasibility and effectiveness of implementing the intervention in this patient population. The primary clinical outcome is the AF detection rate, and the primary feasibility outcome is the patient satisfaction score. Other outcomes include appropriate use of anticoagulant therapy, participant recruitment rate, program engagement (eg, frequency of ECG transmission), agreement in ECG interpretation between the device automatic algorithm and clinicians, the proportion of participants who complete the trial and number of dropouts, and the impact of frailty on feasibility and outcomes. We will conduct a qualitative evaluation to examine the barriers to and acceptability and enablers of implementation. Ethics approval was obtained from the human research ethics committee at the University of Sydney (project number 2020/680). The results will be disseminated via conventional scientific forums, including peer-reviewed publications and presentations at national and international conferences. CONCLUSIONS: By incorporating an integrated health care approach involving patient empowerment, centralized clinician-coordinated ECG monitoring, and facilitation of primary care and specialist services, it is possible to diagnose and treat AF early to reduce stroke risk. This study will provide new information on how to implement AF screening using digital health technology practicably and feasibly for older and frail populations residing in the community. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12621000184875; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380877. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/34778.

Impact of a Pharmacist Intervention in the Emergency Department on the Appropriateness of Direct Oral Anticoagulants Prescribed in Venous Thromboembolism Patients.

BACKGROUND: It is now widely accepted to manage low risk acute venous thromboembolism (VTE) in the outpatient setting with direct oral anticoagulants (DOACs). Although DOACs are straightforward to dose, they are high risk medications and not immune to medication errors. There is limited evidence that pharmacists' intervention has an impact on DOAC discharge medication errors in the ED. OBJECTIVE: To determine if pharmacist involvement reduced the rate of DOAC discharge medication errors in low risk VTE patients. METHODS: This retrospective cohort study evaluated a clinical pharmacy service implemented prior to the study. Included patients were evaluated in 2 groups: the cohort with pharmacist involvement and the cohort without pharmacist involvement. The primary outcome was the rate of anticoagulation medication errors. RESULTS: A total of 58 patients were evaluated. Of these patients, 14 had a pharmacist directly involved with their care in the ED while 44 patients did not. The rate of medication errors was lower when a pharmacist was involved, 7.1% (n = 1), compared to when a pharmacist was not involved, 36.4% (n = 16), (p = 0.046). All patients in the pharmacist involvement group received anticoagulation counseling prior to discharge compared to only 56.8% of patients in the non-pharmacist involvement group (p = 0.002). CONCLUSION: Our protocol for pharmacist involvement at the time of VTE diagnosis during an ED admission showed a reduced rate of anticoagulation medication errors when a pharmacist was involved. This benefit could potentially translate into improved outcomes such as readmission rates, patient safety outcomes, and hospitalizations.

Increases in both HIV and syphilis among men who have sex with men in Vietnam: Urgent need for comprehensive responses.

The objective of this study was to determine the temporal trends and factors associated with HIV and syphilis infection among men who have sex with men (MSM) in southern Vietnam. Data from the 2014-2018 national HIV sentinel surveillance of MSM aged 16 years or older were collected from three provinces, including An Giang (N = 761), Can Tho (N = 900), and Ho Chi Minh City (N = 1426), and examined for changes in prevalence rates of HIV and syphilis and risk behaviors over time. Multivariate logistic regression was performed to assess the trends and correlates of HIV and syphilis infections among MSM. There were upward trends for HIV (9.5% in 2014 to 14.2% in 2018, p-trend<0.01), syphilis (4.9% in 2014 to 8.0% 2018, p-trend<0.01), and HIV/syphilis co-infection (1.9% in 2014 to 3.1% in 2018, p-trend=0.01). Factors associated with HIV infection included place of residence, early sexual debut, consistent condom use and not engaging in anal sex during the past month, not knowing one's HIV test results, having ever injected drugs, and having active syphilis. Additionally, early sexual debut and being HIV positive were associated with syphilis infection. Rising prevalences of these infections among MSM suggests an urgent need for comprehensive intervention packages for HIV/STI prevention.