Managing Medications During "Sick Days" in Patients With Diabetes, Kidney, and Cardiovascular Conditions: A Theory-informed Approach to Intervention Design and Implementation.

OBJECTIVES: Our aim in this work was to 1) explore barriers and enablers to patient and health-care provider (HCP) behaviours related to sick-day medication guidance (SDMG), 2) identify theory-informed strategies to advise SDMG intervention design, and 3) obtain perspectives on an eHealth tool for this purpose. METHODS: A qualitative descriptive study using qualitative conventional content analysis was undertaken. Interviews and focus groups were held with patients and HCPs from January 2021 to April 2022. Data were analyzed using the Behaviour Change Wheel and Theoretical Domains Framework to inform intervention design. RESULTS: Forty-eight people (20 patients, 13 pharmacists, 12 family physicians, and 3 nurse practitioners) participated in this study. Three interventions were designed to address the identified barriers and enablers: 1) prescriptions provided by a community-based care provider, 2) pharmacists adding a label to at-risk medications, and 3) built-in prompts for prescribing and dispensing software. Most participants accepted the concept of an eHealth tool and identified pharmacists as the ideal point-of-care provider. Challenges for an eHealth tool were raised, including credibility, privacy of data, medical liability, clinician remuneration and workload impact, and equitable access to use of the tool. CONCLUSIONS: Patients and HCPs endorsed non-technology and eHealth innovations as strategies to aid in the delivery of SDMG. These findings can guide the design of future theory-informed SDMG interventions.

Establishment and Validation of Novel Prognostic Subtypes in Hepatocellular Carcinoma Based on Bile Acid Metabolism Gene Signatures Using Bulk and Single-Cell RNA-Seq Data.

Hepatocellular carcinoma (HCC) is a highly detrimental cancer type and has limited therapeutic options, posing significant threats to human health. The development of HCC has been associated with a disorder in bile acid (BA) metabolism. In this study, we employed an integrative approach, combining various datasets and omics analyses, to comprehensively characterize the tumor microenvironment in HCC based on genes related to BA metabolism. Our analysis resulted in the classification of HCC samples into four subtypes (C1, C2a, C2b, and C3). Notably, subtype C2a, characterized by the highest bile acid metabolism score (BAMS), exhibited the highest survival probability. This subtype also demonstrated increased immune cell infiltration, lower cell cycle scores, reduced AFP levels, and a lower risk of metastasis compared to subtypes C1 and C3. Subtype C1 displayed poorer survival probability and elevated cell cycle scores. Importantly, the identified subtypes based on BAMS showed potential relevance to the gene expression of drug targets in currently approved drugs and those under clinical research. Genes encoding VEGFR (FLT4 and KDR) and MET were elevated in C2, while genes such as TGFBR1, TGFB1, ADORA3, SRC, BRAF, RET, FLT3, KIT, PDGFRA, and PDGFRB were elevated in C1. Additionally, FGFR2 and FGFR3, along with immune target genes including PDCD1 and CTLA4, were higher in C3. This suggests that subtypes C1, C2, and C3 might represent distinct potential candidates for TGFB1 inhibitors, VEGFR inhibitors, and immune checkpoint blockade treatments, respectively. Significantly, both bulk and single-cell transcriptome analyses unveiled a negative correlation between BA metabolism and cell cycle-related pathways. In vitro experiments further confirmed that the treatment of HCC cell lines with BA receptor agonist ursodeoxycholic acid led to the downregulation of the expression of cell cycle-related genes. Our findings suggest a plausible involvement of BA metabolism in liver carcinogenesis, potentially mediated through the regulation of tumor cell cycles and the immune microenvironment. This preliminary understanding lays the groundwork for future investigations to validate and elucidate the specific mechanisms underlying this potential association. Furthermore, this study provides a novel foundation for future precise molecular typing and the design of systemic clinical trials for HCC therapy.

Research on Symptomatic Treatment Decision Support System Based on Natural Language Process (NLP) for Medication Guidance.

This study is to test the technologies related to natural language processing (NLP) and text analysis to solve the problem of symptom analysis and symptomatic treatment for healthcare workers and patients after large-scale outbreaks of infectious diseases. Using the keyword extraction tool based on NLP technology combined with text analysis, the symptom description of the infected population obtained from the questionnaire survey was analyzed, and the efficacy of the symptomatic treatment drug was analyzed, and finally a pre-experimental system of online symptomatic treatment support drug selection system was produced. Through natural language processing (NLP) and text analysis of the symptoms of infected people, we found that high-frequency symptoms were mainly reflected in: nasal congestion, sore throat, fever and other high-frequency keywords, and through the analysis of alternative drug libraries, we also found that the drugs were mainly concentrated in: cold medicines, antipyretic drugs,and traditional Chinese medicines. In the early stage of infectious disease outbreak, it is difficult to use the existing drug library to make a prompt system under the premise of insufficient data collection, and a relatively complete symptomatic treatment support medication system can be formed after accumulating certain samples.

Intelligent medication manager: developing and implementing a mobile application based on WeChat.

Background: Time and space constraints have often hindered the provision of optimal pharmaceutical care, limiting medication therapy management. Social media tools have gained significant popularity in the field of pharmaceutical care. This study aimed to develop a WeChat-based intelligent medication manager platform that facilitates online pharmaceutical care and encourages self-management. Methods: We developed a WeChat-based Internet pharmacy service platform called Xiang Medicine Guidance (XMG). Through the analysis of surveys and user access data, we evaluated the demand and utilization of the XMG platform and assessed patients' satisfaction with its services. Patients' adherence before and after the XMG platform intervention was also investigated. Results: The XMG platform was launched in November 2022, offering medication guidance, reminders, and consultation services through the WeChat mini-program. By the end of April 2023, the platform had attracted 141.2 thousand users, accumulating 571.0 thousand visits. Moreover, 1,183 clients sought online medication consultations during this period. Six months after the launch of XMG, an impressive 91.02% of users expressed their satisfaction with the platform. The medication reminders and consultations provided by XMG significantly contributed to medication adherence, with 56.02% of users categorized as having good adherence, better than the previous 47.26%. Conclusion: Through its services and features, XMG empowers patients to better manage their medications, seek professional advice, and adhere to their prescribed treatment plans. XMG has the potential to positively impact public health on a broader scale.

Improvement of Medication Guidance Sheet for Total Body Irradiation/Cyclophosphamide Followed by Allogeneic Hematopoietic Stem Cell Transplantation Based on Real Monitoring Data.

BACKGROUND/AIM: Adverse events (AEs) must be managed during cancer therapy. We had previously developed a medication guidance sheet (MGS) to monitor AEs after conditioning therapy with allogeneic hematopoietic stem cell transplantation (HSCT). However, it remains unclear whether this sheet can accurately predict the type, onset, and duration of AEs in clinical practice. In this study, we evaluated the clinical utility of the original MGS in patients receiving total body irradiation (TBI) and cyclophosphamide (CY). PATIENTS AND METHODS: Fifty-eight patients who underwent TBI/CY were included. The types, onsets, and durations of AEs observed during real monitoring were compared with those listed in the original MGS. RESULTS: A total of 361 subjective AE symptoms were observed, all of which were predictive, as listed in the MGS. However, the durations of several AEs were longer than expected. Thus, the prediction accuracy for all AEs was 67.0%. The accuracy rate was the lowest for anorexia (6.7%), followed by diarrhea (42.6%), and nausea/vomiting (55.6%). Acute graft versus host disease (GVHD) most likely caused the prolongation of AEs. Subsequently, the original MGS was revised to account for the possible occurrence of acute GVHD. CONCLUSION: When monitoring AEs in patients receiving a TBI/CY conditioning regimen for HSCT, the involvement of acute GVHD-associated AEs should be considered. In this respect, the present modified MGS is particularly useful for rapid and accurate monitoring of AEs.

Sick Day Medication Guidance for People With Diabetes, Kidney Disease, or Cardiovascular Disease: A Systematic Scoping Review.

Rationale & Objective: Sick day medication guidance has been promoted to prevent adverse events for people with chronic conditions. Our aim was to summarize the existing sick day medication guidance and the evidence base for the effectiveness of interventions for implementing this guidance. Study Design: Scoping review of quantitative and qualitative studies. Setting & Population: Sick day medication guidance for people with chronic conditions including diabetes mellitus, kidney diseases, and cardiovascular diseases. Selection Criteria for Studies: A search of 6 bibliographic databases (Ovid MEDLINE, Ovid Embase, CINAHL, Scopus, Web of Science Core Collection, and Cochrane Library [via Wiley]) and a comprehensive gray literature search were completed in June 2021. Data Extraction: Intervention and study characteristics were extracted using standardized tools. Analytical Approach: Data were summarized descriptively, and our approach observed the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews. Results: The literature search identified 2,308 documents, which were screened against the eligibility criteria, leading to 74 documents that were included. The majority of the identified documents (n = 55) were guidelines or educational resources. Of the 19 primary research studies identified, 10 studies described an intervention, with only 2 examining the effect of sick day medication guidance interventions within clinical care and no studies reporting beneficial effects on clinical outcomes. Most documents (n = 58) included guidance specific to patients with diabetes mellitus, with fewer including guidance for patients with chronic kidney disease (n = 9) or heart failure (n = 2). Limitations: Risk of bias was not assessed. Conclusions: Many resources promoting sick day medication guidance have been developed; however, there is very little empirical evidence for the effectiveness of current approaches in implementing sick day medication guidance into practice. Recommendations for the use of sick day medication guidance will require further research to develop consistent, understandable, and usable approaches for its implementation within self-management strategies as well as empirical studies to demonstrate the effectiveness of these interventions.

Usefulness of Medication Guidance Sheets for Patients With Non-Hodgkin's Lymphoma Receiving ESHAP±R Therapy.

BACKGROUND/AIM: The occurrence of chemotherapy-related serious adverse events (AEs) is associated with a poor prognosis of hematopoietic malignancies. We have developed a medication guidance sheet (MGS) for monitoring AEs occurring when combining chemotherapy with etoposide, methylprednisolone, cisplatin, cytarabine, and rituximab (ESHAP±R). In this study, the usefulness of MGS was investigated in non-Hodgkin's lymphoma patients. PATIENTS AND METHODS: The MGS was used to monitor AEs in 48 adult patients receiving ESHAP±R. The prediction accuracy of the MGS was estimated before and after modification based on practical data. RESULTS: A total of 246 AEs developed, all of which were predicted by the MGS. Among them, 149 events (61%) occurred during the same period as those predicted by the MGS. After modification of MGS for the onset and duration of AEs, the accuracy increased to 84%. CONCLUSION: The accuracy of the original MGS for ESHAP±R was insufficient but greatly improved after the AEs duration modification.

The direct application of plasma droplet digital PCR in the ultra-early pathogen detection and warning during sepsis: Case reports.

BACKGROUND: Sepsis is a severe and acute disease associated with high mortality, for those who survive, long-term morbidity. In-time detection of pathogen for proper and optimized treatment in the early stage of sepsis is crucial. METHODS: We performed droplet digital PCR (ddPCR) on two cases of sepsis. The clinical information, laboratory test results, and the therapeutic regimen was detailed recorded. RESULTS: ddPCR showed its clinical value of sepsis ultra-early diagnosis and the guidance of medication in both cases we provided. CONCLUSIONS: ddPCR has potential for rapid and precise diagnose in ultra-early stage of sepsis for its high sensitivity and short turn-around-time, thus benefiting in optimal and timely treatment of sepsis.

Nurse-Provided Medication Guidance for Improving Drug Adherence to Thiopurines in Outpatients With Inflammatory Bowel Disease: A Single-Center Prospective Study.

Background and Aims: Drug adherence is critically important for patients on thiopurines. We examined whether nurse-provided medication guidance improves drug adherence to thiopurines and clinical activity in patients with inflammatory bowel disease (IBD). Methods: IBD outpatients taking a stable dose of thiopurines for 1 year were enrolled. After a baseline survey including the Morisky Medication Adherence Scale (MMAS)-8, nurses provided medication guidance to each patient using a specialized leaflet. The same survey was conducted 2 and 6 months after the guidance. Results: Among 110 enrolled patients, 74 met the analysis criteria. In the low adherence group (MMAS-8 <6), the median MMAS-8 score significantly increased from 4 (range 1-5.75) to 5.25 (2-7) at 2 months (P = .0135) to 5.625 (2.5-7.75) at 6 months (P = .0004), but not in overall or the high adherence group (MMAS-8 ≥6). Older age (≥43 years, odds ratio [OR] = 5.63, 95% confidence interval [CI]: 1.59-19.9, P = .0074) and shorter disease duration (<129 months, OR = 6.78, 95% CI: 1.77-26.0, P = .0052) were independently associated with high adherence. Although clinical activity scores did not change during the observation period, the overall mean corpuscular volume (MCV) level significantly increased from 92.3 fL (61.4-105.5) to 92.5 (73.7-107.8) at 2 months (P = .0288) and 93.9 (74.4-107.6) at 6 months (P = .0062). MCV levels significantly increased in the low adherence group at 6 months (92.2 [72.2-105.5] to 94.0 [74.4-107.6], P = .0392) and tended to increase in the high adherence group (92.3 [61.4-101.2] to 93.6 [74.9-99.7], P = .0651). Conclusions: Nurse-provided medication guidance improved drug adherence to thiopurines in IBD patients with low adherence and can also benefit those with high adherence.

Trends and Issues in Patient Questions at Community Pharmacies: Validation with Data from Two Pharmacies with Different Patient Populations / 社会薬学

In Japan, based on the Ministry of Health, Labour and Welfare’s “Pharmacy Vision for Patients” (2015), there has been a growing need to shift from “drug-centered, physical work” to “patient-centered, interpersonal work.” Medication counseling is one of the most important tasks of pharmacists. In the present study, we focused on the questions asked by patients during medication counseling, and statistically analyzed the content of the questions and the patient attributes obtained from the patient medication profile. The study was conducted from 2018 to 2019 on patients who visited two pharmacies. Data from a total of 3,300 patients was collected, of which 859 asked questions during medication counseling, accounting for about 26% of the total. Attributes that significantly influenced the asking of questions included gender, new prescriptions, and who was being instructed, especially for women and parents of infants. In terms of topic, questions about the duration and timing of taking the medication and about the medication itself were common in all departments. In terms of medication effects, there were many questions about topical and central nervous system medications, but there were also questions about non-medication matters such as tests. When providing medication counseling, it is expected that pharmacists will actively provide instructions to resolve patients’ questions based on the characteristics of each pharmacy and on patient demographics, as well as improve the quality of interpersonal services according to the patient’s background.

Evaluation of the M*Adhere Standard for Patient Efficacy and Health Economics System (M*Adhere SPEHEC® ) in Pharmaceutical Management / 医薬品情報学

Objective: In order to increase the efficiency and effectiveness of pharmacotherapy and maximize the benefit/risk ratio, patient follow-up after medication is imperative. Such follow-up includes medical adherence, drug efficacy, early detection and treatment of adverse events. All pharmacy pharmacists should, at their service counter, select and correctly identify the most noticeable symptoms of adverse drug reactions for the patient, especially with their other roles and responsibilities. Thus, we evaluated the usefulness of M*Adhere SPEHEC® in pharmaceutical management.Methods: During the month of April 2019, 21 pharmacists at six pharmacies responded to the survey.Results: Of 21 pharmacists, 18 (85.7%) stated that the efficiency and/or quality of pharmacotherapy management had improved. The system enabled evidence-based identification of drug adverse event symptoms, and the time for pharmaceutical care was reduced by an average of 2 min.Conclusion: Based on these results, M*Adhere SPEHEC® was confirmed to be highly useful in improving the efficiency and quality of pharmaceutical management for patient follow-up.

Comparisons of Japanese Kanpo medicine and Chinese patent medicine for medication guidance / 中草药

With the promulgation of the “Chinese Medicine Act”, the application of classic prescriptions has attracted the attention of various companies. At present, related researches mainly focus on industry, patents, quality, clinic and other aspects, lacking overall research on popularization and application, and the research on pharmaceutical instructions has received increasing attention as a link in applied research. Reviewing the existing literature on Chinese patent medicine specification research in China, we found that most studies are qualitative analysis, lack of targets, data comparison, and specific recommendations, so the specific improvement of the Chinese patent medicine specification is limited. In this paper, the 128-item Japanese Kampo preparation instructions and related medication instructions were studied. The specific differences between the Japanese Kampo preparations and Chinese patent medicines in the selection of traditional Chinese medicines, the contents of the specific manuals, and the contents of the index and guidance manual were analyzed. Preliminary analysis and suggestions were made on the establishment of the classic prescription name list, the contents of the drug instruction manual, the improvement of the indexing method, and the establishment of overall instruction manual and the application database, in order to provide references for the application and development of traditional Chinese medicine.

Effects of medication guide on IL-17, NO, IL-8 and respiratory function in patients with COPD / 中国基层医药

Objective To investigate the effect of medication guide on IL-17,NO,IL-8 and the respiratory function in patients with COPD,and to provide evidence for the prevention and treatment of COPD.Methods From January 2014 to December 2015,100 patients with COPD in our hospital were selected,and 3 months medication guide was given to the patients.The IL-8,IL-17,NO and other oxidative stress index were observed before and after the intervention.Results Before the intervention,the IL-17,IL-8 and NO levels of patients were (77.48 ± 5.48) ng/mL,(216.48 ± 29.40) ng/mL,(59.74 ± 10.38) mol/L respectively.After the intervention,the IL-17,IL-8 and NO levels were (28.57 ± 3.94) ng/mL,(43.80 ± 3.69) ng/mL and (78.62 ± 11.49) μmol/L.The levels of IL-17 and IL-8 were significantly decreased after the intervention,the level of NO was significantly increased (t =7.49,4.83,6.59,all P ＜ 0.05).Before the intervention,the levels of FEV1,FVC and FEV1/FVC were (50.24 ± 3.27) ％,(1.24 ± 0.38) L and (53.52 ± 2.37) ％ respectively.After intervention,the levels of FEV1,FVC and FEV1/FVC were (74.46 ± 5.74) ％,(1.99 ± 0.41) L and (83.27 ± 3.25) ％ respectively.The respiratory parameters of the patients after intervention were significantly increased (t =6.38,3.89,7.02,all P ＜ 0.05).After 3 months of intervention,in 100 patients,7 cases of grade 0,33 cases of grade Ⅰ,54 cases of grade Ⅱ,6 cases of grade Ⅲ,through statistical analysis,compared with those before intervention,significantly improved (x2 =6.49,all P ＜ 0.05).Conclusion After 3 months of intervention,the patients' respiratory function limit improved,the condition improved significantly,and the medication guide for the patients with COPD has a positive effect.

Skills Clinical Pharmacists Applied in Guiding Medication of Insulin and Its Analogs for Patients with Type 2 Diabetes Mellitus / 中国药房

OBJECTIVE: To introduce the skills clinical pharmacists applied in guiding the use of insulin and its analogs in patients with type 2 diabetes mellitus.METHODS: The related knowledge needed to be mastered by clinical pharmacists were reviewed,and based on our clinical practice,the skills in offering guidance for the use of insulin and its analogs in patients with type 2 diabetes mellitus were proposed.RESULTS & CONCLUSION: Clinical pharmacists can take advantage of their expertise and skills accumulated in clinical practice to provide better pharmaceutical care for patients with type 2 diabetes mellitus.