Artificial intelligence to assist decision-making on pharmacotherapy: A feasibility study.

Background: Artificial intelligence (AI) has the capability to analyze vast amounts of data and has been applied in various healthcare sectors. However, its effectiveness in aiding pharmacotherapy decision-making remains uncertain due to the intricate, patient-specific, and dynamic nature of this field. Objective: This study sought to investigate the potential of AI in guiding pharmacotherapy decisions using clinical data such as diagnoses, laboratory results, and vital signs obtained from routine patient care. Methods: Data of a previous study on medication therapy optimization was updated and adapted for the purpose of this study. Analysis was conducted using R software along with the tidymodels extension packages. The dataset was split into 74% for training and 26% for testing. Decision trees were selected as the primary model due to their simplicity, transparency, and interpretability. To prevent overfitting, bootstrapping techniques were employed, and hyperparameters were fine-tuned. Performance metrics such as areas under the curve and accuracies were computed. Results: The study cohort comprised 101 elderly patients with multiple diagnoses and complex medication regimens. The AI model demonstrated prediction accuracies ranging from 38% to 100% for various cardiovascular drug classes. Laboratory data and vital signs could not be interpreted, as the effect and dependence were unclear for the model. The study revealed that the issue of AI lag time in responding to sudden changes could be addressed by manually adjusting decision trees, a task not feasible with neural networks. Conclusion: In conclusion, the AI model exhibited promise in recommending appropriate medications for individual patients. While the study identified several obstacles during model development, most were successfully resolved. Future AI studies need to include the drug effect, not only the drug, if laboratory data is part of the decision. This could assist with interpreting their potential relationship. Human oversight and intervention remain essential for an AI-driven pharmacotherapy decision support system to ensure safe and effective patient care.

Development and validation of the 15-STARS - A novel self-report pharmacy-based questionnaire to screen for medication non-adherence.

BACKGROUND: Published scales measuring medication adherence are myriad. There is a need for a tool that guides towards downstream adherence interventions. OBJECTIVE: To develop and validate a self-report questionnaire able to detect modifiable determinants of medication non-adherence. METHODS: Workshops, surveys and meetings were used to identify items. Validation was performed in French and German (Switzerland) between March and April 2022. Face validation, content validation, construct validation, internal consistency and test-retest reliability were assessed. The questionnaire was finalized in August 2022. RESULTS: The first draft in English included 13 items divided into four areas. Following translation, validation was performed with 144 patients (63 German-, 81 French-speaking) who were recruited in 35 community pharmacies. Acceptability was good (<5% missing data). Psychometric properties were acceptable with good content validity and moderate construct validity. Internal consistency was acceptable for the French version (Cronbach's alpha = 0.71 [item 1-5] - 0.61 [item 6-9]) and less acceptable for the German version (Cronbach's alpha = 0.43 [item 1-5] - 0.45 [item 6-9]). Test-retest was given for all items (r = 0.52 to 1.0) except item 10 in French (r = 0.25). The final instrument is a 15-item questionnaire called the 15-STARS (Screening Tool for AdheRence to medicineS) that assesses practical difficulties with medicine use, reasons for non-adherence, doses missed, and need for further help. CONCLUSIONS: Our findings support the validity and clinical utility of the 15-STARS questionnaire. Reliability was inconclusive due to incoherent internal consistency, but explainable by the single-item nature of the scale. This new tool will enable the detection of patients who experience difficulties that negatively influence medication adherence. Pharmacists will be able to propose specific and tailored adherence interventions to the patients. Next steps will focus on evaluating its usefulness for developing targeted interventions that optimize medication adherence in routine care and research settings.

Evaluation of parents' attitudes and practices related to antibiotic use for their children in Kosovo: a cross-sectional survey.

BACKGROUND: Self-medication and lack of patient adherence contribute to antibiotic misuse. This article describes parents' attitudes and practices regarding use of antibiotics by their children in Kosovo. METHODS: A cross-sectional survey was conducted during data collection. We surveyed a total of 453 parents of children aged 0-15 years, who had experiences with using antibiotics for their children. Correlation tests and regression analysis were used to explore the relationship between variables. RESULTS: Our findings showed that 42.2% of parents strongly agreed or agreed with the use of antibiotics as a means to cure a cold or flu in their child more quickly. In addition, 29.8% were not aware of antibiotic side effects. Non-compliance with antibiotic treatment was 35.8%, and 28.9% of surveyed parents suggested that they had pressured their pediatricians to prescribe antibiotics for their children. A total of 10.15% of parents had no information on antibiotic resistance, and 34.38% of parents responded that they did not believe that self-medication with antibiotics could lead to resistance. Regression analysis results indicated that gender and age group have a significant influence on the parents' decision that an antibiotic should be used in children with high fever (p < 0.001). CONCLUSIONS: Our findings suggest that antibiotic management by parents in Kosovo is not satisfactory, and more attention should be given to their knowledge of the side effects of antibiotics, bacterial resistance and reduction in the self-medication. Health education, adequate measures and interventions are needed to overcome this situation and ensure rational use of antibiotics in Kosovo.

Clinical impact of a multifaceted intervention aimed at decreasing distress in people living with dementia: evaluating the Reconnect program.

Background: To better meet the needs of people living with advanced dementia, Orchard Care Homes, United Kingdom have established an enhanced person focused program, namely the Reconnect program, which provides an enriched psycho-social care to enhance peoples' quality of life and well-being. Here we aimed to review the impact of this program on people living with dementia. Methods: In this study the implementation of the Reconnect program was evaluated for two six-month periods (April-September 2020 and April-September 2021). The focus of this evaluation was on three key interventions: increasing meaningful occupation and engagement; improving pain identification and management, and reducing constipation. The Reconnect program was conducted in a single for-profit care home. It involved residents with complex dementia needs who previously not responded to support in alternative settings or found previous care ineffective in relieving their distress and reducing risks they pose to themselves or others. Results: A total of 24 people participated in the program during this evaluation. We observed a substantial increase in engagement in meaningful activity per person, including an increase of outdoor access to fresh air. Pain management improved as evidenced by more standardized pain assessments using the PainChek system and coverage of people with either regular and/or "when required" pain management. Constipation relief also improved. For the two comparison periods, distress responses per resident reduced from 14.5 to 10.6 events and use of regular pain relief increased from 21.7 to 48.1%. Use of "when required" benzodiazepine halved from 6 months average of 46 to 23.2 doses given. Benzodiazepine dose reductions increased from 13.3 to 31.8%, while cessations increased from 20 to 50%. We also observed a reduction from 76.3 to 56.3% in antipsychotic use. Their dose reductions increased from 8.3 to 40% and drug cessation was made in 30% of people using antipsychotics (compared to the first period in which no medication cessation was observed). A 91.7% reduction (i.e., from 36 to 3 events) in safeguarding events related to behaviors was also observed. Conclusion: Introduction of the Reconnect program, through its interventions focused on meaningful activity engagement, pain management and constipation relief resulted in substantial improvements related to people's distress, safeguarding and psychotropic use.

Pain assessment tools for use in infants: a meta-review.

BACKGROUND: Identifying pain in infants is challenging due to their inability to self-report pain, therefore the availability of valid and reliable means of assessing pain is critical. OBJECTIVE: This meta-review sought to identify evidence that could guide the selection of appropriate tools in this vulnerable population. METHODS: We searched Scopus, Medline, Embase, CINAHL, MIDRIS, EMCare and Google Scholar for eligible systematic reviews. Eligible reviews documented psychometric properties of available observational tools used to assess pain in infants. RESULTS: A total of 516 reviews were identified of which 11 met our inclusion criteria. We identified 36 pain assessment tools (evaluated in 11 reviews) of which seven were reported in at least three reviews. The level of evidence reported on the psychometric properties of pain assessment tools varied widely ranging from low to good reliability and validity, whilst there are limited data on usability and clinical utility. CONCLUSIONS: Currently, no observer administered pain assessment tool can be recommended as the gold standard due to limited availability and quality of the evidence that supports their validity, reliability and clinical utility. This meta-review attempts to collate the available evidence to assist clinicians to decide on what is the most appropriate tool to use in their clinical practice setting. It is important that researchers adopt a standard approach to evaluating the psychometric properties of pain assessment tools and evaluations of the clinical utility in order that the highest level of evidence can be used to guide tool selection.

Technology-guided assessment of vocalisations and their diagnostic value as pain indicators for people living with dementia.

BACKGROUND: during pain assessment in persons unable to self-report, such as people living with dementia, vocalisations are commonly used as pain indicators. However, there is a lack of evidence from clinical practice regarding their diagnostic value and relationship with pain. We aimed to explore vocalisations and pain in people with dementia undergoing pain assessments in clinical practice settings. METHODS: a total of 22,194 pain assessments were reviewed in people with dementia (n = 3,144) from 34 different Australian aged care homes and two dementia specific programs. Pain assessments were conducted by 389 purposely trained health care professionals and cares using PainChek pain assessment tool. Vocalised expressions were determined based on nine vocalisation features included in the tool. Linear mixed models were used to examine the relationship of pain scores with vocalisation features. Using a single pain assessment for each of the 3,144 people with dementia, additional data analysis was conducted via Receiver Operator Characteristic (ROC) analysis and Principal Component Analysis. RESULTS: vocalisation scores increased with increasing pain intensity. High pain scores were more likely with the presence of sighing and screaming (8 times). The presence of vocalisation features varied depending on the intensity of pain. The ROC optimal criterion for the voice domain yielded a cut-off score of ≥2.0 with a Youden index of 0.637. The corresponding sensitivity and specificity were 79.7% [confidence interval (CI): 76.8-82.4%] and 84.0% (CI: 82.5-85.5%), respectively. CONCLUSION: we describe vocalisation features during presence of different levels of pain in people with dementia unable to self-report, therefore providing evidence in regard to their diagnostic value in clinical practice.

The Clinical Suitability of an Artificial Intelligence-Enabled Pain Assessment Tool for Use in Infants: Feasibility and Usability Evaluation Study.

BACKGROUND: Infants are unable to self-report their pain, which, therefore, often goes underrecognized and undertreated. Adequate assessment of pain, including procedural pain, which has short- and long-term consequences, is critical for its management. The introduction of mobile health-based (mHealth) pain assessment tools could address current challenges and is an area requiring further research. OBJECTIVE: The purpose of this study is to evaluate the accuracy and feasibility aspects of PainChek Infant and, therefore, assess its applicability in the intended setting. METHODS: By observing infants just before, during, and after immunization, we evaluated the accuracy and precision at different cutoff scores of PainChek Infant, which is a point-of-care mHealth-based solution that uses artificial intelligence to detect pain and intensity based solely on facial expression. We used receiver operator characteristic analysis to assess interpretability and establish a cutoff score. Clinician comprehensibility was evaluated using a standardized questionnaire. Other feasibility aspects were evaluated based on comparison with currently available observational pain assessment tools for use in infants with procedural pain. RESULTS: Both PainChek Infant Standard and Adaptive modes demonstrated high accuracy (area under the curve 0.964 and 0.966, respectively). At a cutoff score of ≥2, accuracy and precision were 0.908 and 0.912 for Standard and 0.912 and 0.897 for Adaptive modes, respectively. Currently available data allowed evaluation of 16 of the 17 feasibility aspects, with only the cost of the outcome measurement instrument unable to be evaluated since it is yet to be determined. PainChek Infant performed well across feasibility aspects, including interpretability (cutoff score defined), ease of administration, completion time (3 seconds), and clinician comprehensibility. CONCLUSIONS: This work provides information on the feasibility of using PainChek Infant in clinical practice for procedural pain assessment and monitoring, and demonstrates the accuracy and precision of the tool at the defined cutoff score.

The role of the clinical pharmacist in mental health hospital-in-the-home: A scoping review.

BACKGROUND: The concept of integrating a clinical pharmacist (CP) within a Hospital-in-the-Home (HiTH) program is relatively new. Little is known about the role of a pharmacist in HiTH programs focused on mental health (MH). OBJECTIVES: To describe the role of a CP within an MH-HiTH program, focusing on the specific tasks performed by a pharmacist in this position, their benefits and limitations. METHODS: MEDLINE, CINAHL, EMBASE, Cochrane Database of Systematic Reviews, PsycINFO, Web of Science and the grey literature were searched without any date limits for references in English that included 2 or more of the following key terms (or their synonyms): "HiTH", "clinical pharmacist" and "mental health". Two reviewers independently screened and analysed the data. RESULTS: Of 60,482 screened references, 6 included all 3 key terms: 2 were HiTH guideline documents, 2 were conference abstracts and 2 were journal articles. These papers discussed MH-HiTH programs or similar home-care services where a CP was incorporated in the treating team to address medication management and adherence during a home visit. There is evidence that MH-HiTH CPs identify and resolve medication-related problems (MRPs), as well as improve medication adherence, patient care, hospital admission rates and emergency department presentations. An additional 54 references including 2 key terms provided corroborating evidence of an MH-HiTH CP role focused on improving patient care via 4 key groups of tasks: clinical pharmacy, mental healthcare, home medicines review and facilitation of care transition through medication reconciliation and follow-up. CONCLUSIONS: Although there is currently a paucity of literature describing the incorporation of a CP in an MH-HiTH program, preliminary evidence shows it can improve medication management. This has potential to improve patient outcomes as has been seen in similar home-based settings, but limitations such as time constraints are notable barriers. More robust studies are needed to evaluate these outcomes.

Impact of a clinical pharmacist on medication safety in mental health Hospital-in-the-Home: a retrospective analysis.

BACKGROUND: Integration of clinical pharmacists into multidisciplinary Mental Health Hospital-in-the-Home teams is increasing but little is known about the medication safety contribution these pharmacists make. AIM: To evaluate whether clinical pharmacist involvement in a Mental Health Hospital-in-the-Home service improved medication safety key performance indicators. METHOD: Medical records were retrospectively reviewed of all patients admitted to 2 Western Australian Mental Health Hospital-in-the-Home services from September to November 2015. SITE 1: was a 16-bed service incorporating a clinical pharmacist as part of its multidisciplinary team. SITE 2: was a similarly structured 18-bed service but without clinical pharmacist involvement. The primary outcome measure was completion of medication safety key performance indicators obtained from the Western Australian Government Pharmaceutical Review Policy and mental health-specific best practice guidelines. RESULTS: Key performance indicators from Site 1 (n = 75 records), which incorporated a clinical pharmacist, demonstrated significantly (p < 0.001) higher rates of completion of medication reconciliation [65 (87%) versus 17 (29%)], accurate adverse drug reaction list [73 (97%) versus 34 (58%)], accurate discharge medication list [51 (74%) versus 18 (45%)], accurate medication profile [74 (99%) versus 40 (68%)] and medication chart review [74 (99%) versus 0 (0%)] than Site 2 (n = 59). CONCLUSION: Integrating a clinical pharmacist into a Mental Health Hospital-in-the-Home program significantly improved achievement of medication safety key performance indicators.

Establishment and evolution of a clinical pharmacy mental health hospital-in-the-home service: An autoethnography.

BACKGROUND: Hospital-in-the-Home (HiTH) services provide "inpatient-style" care for patients at home. While relatively well known in non-psychiatric settings, little is known about mental health (MH)-HiTH services, with even less known about the role of a clinical pharmacist (CP) within a MH-HiTH multidisciplinary team (MDT). OBJECTIVE: The aim of this paper is to describe the evolution of the first MH-HiTH MDT in Western Australia and the various facets of the CP's role integrated within the service. METHOD: The integration of a CP into a non-traditional practice setting represents a cultural change in the pharmacy profession. Hence, this paper utilised a descriptive-realistic style of the autoethnographic method, with the narrative written in the first-person point of view of the first author (M.F.). It specifically focused on the tasks performed by the team's CP. A narrative analysis approach was used to reflect on the reason these tasks are performed, the potential benefits and limitations of integrating a CP into the team and subsequent cultural influence on the pharmacy profession. FINDINGS: The service commenced in 2014, consisting of an MDT of a consultant psychiatrist, a psychiatric registrar, clinical nurses, an occupational therapist, a social worker and a CP. Starting with 4 then 8 "virtual beds", it was gradually increased to 16 virtual beds. The MH-HiTH CP combined hospital clinical tasks - e.g. medication reconciliation and therapeutic drug monitoring - with home medication reviews as part of the MH-HiTH MDT. Lessons learnt include proactively integrating and flexibly adapting into a novel practice setting. CONCLUSION: There is scope to embed a CP within an MH-HiTH MDT; the major advantage is the inclusion of a comprehensive medication management service. While this is a promising new area where the pharmacy profession is becoming engaged, more studies are needed to quantify and confirm the stated benefits of such service.

Faces of Pain in Dementia: Learnings From a Real-World Study Using a Technology-Enabled Pain Assessment Tool.

Pain is common in people living with dementia (PLWD), including those with limited verbal skills. Facial expressions are key behavioral indicators of the pain experience in this group. However, there is a lack of real-world studies to report the prevalence and associations of pain-relevant facial micro-expressions in PLWD. In this observational retrospective study, pain-related facial features were studied in a sample of 3,144 PLWD [mean age 83.3 years (SD = 9.0); 59.0% female] using the Face domain of PainChek®, a point-of-care medical device application. Pain assessments were completed by 389 users from two national dementia-specific care programs and 34 Australian aged care homes. Our analysis focused on the frequency, distribution, and associations of facial action units [AU(s)] with respect to various pain intensity groups. A total of 22,194 pain assessments were completed. Of the AUs present, AU7 (eyelid tightening) was the most frequent facial expression (48.6%) detected, followed by AU43 (closing eyes; 42.9%) and AU6 (cheek raising; 42.1%) during severe pain. AU20 (horizontal mouth stretch) was the most predictive facial action of higher pain scores. Eye-related AUs (AU6, AU7, AU43) and brow-related AUs (AU4) were more common than mouth-related AUs (e.g., AU20, AU25) during higher pain intensities. No significant effect was found for age or gender. These findings offer further understanding of facial expressions during clinical pain in PLWD and confirm the usefulness of artificial intelligence (AI)-enabled real-time analysis of the face as part of the assessment of pain in aged care clinical practice.

Assessing procedural pain in infants: a feasibility study evaluating a point-of-care mobile solution based on automated facial analysis.

BACKGROUND: The management of procedural pain in infants is suboptimal, in part, compounded by the scarcity of a simple, accurate, and reliable method of assessing such pain. In this study, we aimed to evaluate the psychometric properties of the PainChek Infant, a point-of-care mobile application that uses automated facial evaluation and analysis in the assessment of procedural pain in infants. METHODS: Video recordings of 40 infants were randomly chosen from a purposely assembled digital library of 410 children undergoing immunisation as part of their standard care in Prishtina, Kosovo, between April 4, 2017, and July 11, 2018. For each infant recording, four 10 s video segments were extracted, corresponding to baseline, vaccine preparation, during vaccination, and recovery. Four trained assessors did pain assessments on the video segments of 30 infants, using PainChek Infant standard, PainChek Infant adaptive, the Neonatal Facial Coding System-Revised (NFCS-R) single, the NFCS-R multiple, and the Observer administered Visual Analogue Scale (ObsVAS), on two separate occasions. PainChek Infant's performance was compared to NFCS-R and ObsVAS using correlation in changes in pain scores, intra-rater and inter-rater reliability, and internal consistency. FINDINGS: 4303 pain assessments were completed in two separate testing sessions, on Aug 31, and Oct 19, 2020. The study involved videos of 40 infants aged 2·2-6·9 months (median age 3·4 months [IQR 2·3-4·5]). All pain assessment tools showed significant changes in the recorded pain scores across the four video segments (p≤0·0006). All tools were found to be responsive to procedure-induced pain, with the degree of change in pain scores not influenced by pre-vaccination pain levels. PainChek Infant pain scores showed good correlation with NFCS-R and ObsVAS scores (r=0·82-0·88; p<0·0001). PainChek Infant also showed good to excellent inter-rater reliability (ICC=0·81-0·97, p<0·001) and high levels of internal consistency (α=0·82-0·97). INTERPRETATION: PainChek Infant's use of automated facial expression analysis could offer a valid and reliable means of assessing and monitoring procedural pain in infants. Its clinical utility in clinical practice requires further research. FUNDING: PainChek.

Mobile Electronic Devices as Means of Facilitating Patient Activation and Health Professional Empowerment Related to Information Seeking on Chronic Conditions and Medications: Qualitative Study.

BACKGROUND: Patient activation has an impact on the management of patients' health, clinical outcomes, and treatment costs. Mobile electronic devices (MEDs) have shown the potential to engage patients in wellness behavior. Furthermore, the potentially positive role of MEDs is evident in supporting health professionals in their practice. OBJECTIVE: This study aims to explore the impact of MEDs on patient activation to search for information on chronic conditions and medications and the impact of MEDs on the empowerment of health professionals or future health professionals. METHODS: We conducted 6 focus groups-2 with health sciences students, 2 with health professionals, and 2 with hospitalized patients with chronic conditions. A protocol comprising eight questions was used to guide discussions. Audio-recorded data were transcribed verbatim and analyzed thematically; a ranking system was used to analyze the relevance of identified themes and subthemes, using a coding system depicted by the + symbol, to indicate different relevance levels. RESULTS: Our results suggest that MEDs can positively affect patient activation to search for chronic conditions and medication information by facilitating patients' information-seeking behavior. Key drivers leading to patients' activation to seek information related to chronic conditions and medications through MEDs were the accessibility and abundance of available and detailed information, reduced search time, information updates, and convenience in finding information at any time and place. The lack of accurate information in one's native language, access to incorrect information, and limited access to the internet were key obstacles to seeking information related to chronic conditions and medications via MEDs. In addition, findings of this study suggest that MEDs in general and mobile apps, in particular, may have a positive impact on the work routine of health care professionals as they enable them to make quicker decisions by accessing the required information faster, thus improving practice efficiency. Furthermore, the appropriate usage of MEDs by patients for seeking information about their chronic conditions and medications may positively impact the physician-patient relationship. All focus groups recognized the questionable reliability of health information on the internet and its potential negative effects on patients. Therefore, our findings suggest the need for an additional role of health professionals in assisting patients in using MEDs to search for health and medication information, such as providing reliable websites and mobile apps where patients can safely search for health-related information on the web. CONCLUSIONS: The use of MEDs may help activate patients to seek chronic conditions and medication-related information, potentially leading to better management of their chronic conditions and medications. Our findings also highlight the positive impact MEDs may have on empowering health professionals in their practice and the need for health professionals to help patients through specific education that addresses MEDs utilization for chronic conditions and medication information seeking.

Exploring instruments used to evaluate potentially inappropriate medication use in hospitalised elderly patients in Kosovo.

OBJECTIVES: A number of instruments are used to identify potentially inappropriate medications (PIMs) in the elderly. In this study we identify PIMs in elderly patients and aim to compare three different instruments used to assess PIMs. METHODS: In this prospective cohort study, we compared medications of elderly patients against three commonly used instruments: Beers' list, PRISCUS and STOPP/START, at the point of hospital admission and discharge in the nephrology clinic of Kosovo's largest hospital. Readmission risk was evaluated using the LACE Index and correlations with the number of PIMs and PIMs criteria were analysed. RESULTS: Of 184 patients admitted to the nephrology clinic, 84 met study inclusion criteria. Patients had a median of three drugs at admission and four at discharge. Hospital readmission risk was high with median LACE Index being 11 (63% of patients). A higher number of PIMs was associated at the point of discharge compared with admission for all three tools (Beers' list: 29% vs 38 %, P=0.04; STOPP/STRART: 20% vs 23%, P<0.001; PRISCUS list: 12% vs 21%, P<0.001). The number of drugs at admission predicted the number of PIMs at discharge only when using Beers' criteria (P=0.006). At discharge, each increase in medication was associated with an increase in PIMs based on Beers' [0.134; (P=0.007)] and STOPP/START criteria [0.130; (P=0.005)]. Nitrofurantoin was the main PIM identified with Beers' and PRISCUS list in comparison to proton- pump-inhibitors being the most prevalent agents identified with STOPP/START criteria. CONCLUSIONS: There are differences when using Beers' criteria, STOPP/START criteria and PRISCUS list during identification of PIMs in elderly patients with high readmission risk. These differences should be considered when identifying PIMs in hospital settings.

Evaluation of the Psychometric Properties of PainChek® in UK Aged Care Residents with advanced dementia.

BACKGROUND: The aim of this study was to further validate PainChek®, an electronic pain assessment instrument, with a population living with dementia in a UK care home. METHOD: This study utilised a correlational design to evaluate the psychometric properties of PainChek® when compared to the Abbey Pain Scale (APS). Blinded paired pain assessments were completed at rest and immediately post-movement by a researcher and a nurse. A total of 22 participants with a diagnosis of moderate-to-severe dementia and a painful condition were recruited using opportunity sampling. RESULTS: Overall, 302 paired assessments were collected for 22 participants. Out of these 179 were conducted during rest and 123 were immediately post-movement. The results demonstrated a positive significant correlation between overall PainChek® pain scores and overall APS pain scores (r = 0.818, N = 302, p < .001, one-tailed), satisfactory internal consistency (α = 0.810), moderate single measure intraclass correlation (ICC = 0.680) and substantial inter-rater agreement (κ = 0.719). CONCLUSIONS: PainChek® has demonstrated to be a valid and reliable instrument to assess the presence and severity of pain in people with moderate-to-severe dementia living in aged care.

Assessment of medication self-administration using artificial intelligence.

Errors in medication self-administration (MSA) lead to poor treatment adherence, increased hospitalizations and higher healthcare costs. These errors are particularly common when medication delivery involves devices such as inhalers or insulin pens. We present a contactless and unobtrusive artificial intelligence (AI) framework that can detect and monitor MSA errors by analyzing the wireless signals in the patient's home, without the need for physical contact. The system was developed by observing self-administration conducted by volunteers and evaluated by comparing its prediction with human annotations. Findings from this study demonstrate that our approach can automatically detect when patients use their inhalers (area under the curve (AUC) = 0.992) or insulin pens (AUC = 0.967), and assess whether patients follow the appropriate steps for using these devices (AUC = 0.952). The work shows the potential of leveraging AI-based solutions to improve medication safety with minimal overhead for patients and health professionals.

Provision of community pharmacy services during COVID-19 pandemic: a cross sectional study of community pharmacists' experiences with preventative measures and sources of information.

Background An infectious disease caused by a novel coronavirus (later called COVID-19) reached pandemic levels in 2020 and community pharmacists were involved in responding to this pandemic, also in Kosovo. Objectives To explore the experiences of community pharmacists in relation to provision of community pharmacy services during COVID-19 pandemic. Setting Community pharmacists in Kosovo. Methods This was a cross-sectional study where data was collected via a self-administered online questionnaire, from 264 pharmacists actively practicing in Kosovo during the pandemic. The questionnaire consisted of a combination of closed and open-ended questions, optional statements and statements on a five-point Likert scale, derived at least in part from the Transtheoretical Model. One-way analysis of variance was used to analyze differences in responses to Likert-type items whereas categorical variables were analyzed using Chi square testing. Main outcome measures Community pharmacists' perceptions on COVID-19 related preventative measures. Results A response rate of 40.6% was achieved. Sufficient and adequate COVID-19-related preventative measures were being implemented by a majority of pharmacies (n = 232; 87.9%), and over two-thirds of respondents agreed/strongly agreed that their pharmacies were sufficiently prepared with protective equipment for their personnel. Implementation of preventative measures was associated with respondents' perception that pharmacists and the pharmacy profession were valued more by patients during the pandemic and to a lesser degree, by other health professionals. Most commonly stated pros dealt with employee and patient safety, while key cons dealt with increased costs and running out of the necessary protective equipment. Key barriers to pharmacy activities were price increases by wholesalers, and patients' panic and excessive buying, whereas drivers dealt with professional obligation to assist and opportunity to prove inseparable to other health professionals. The most popular means of accessing COVID-19 related information by pharmacists was via mobile devices and information from professional organizations was considered most useful by pharmacists. Conclusions Community pharmacies actively implemented various measures as precautions to mitigate the spread of COVID-19. Our findings highlight the value of continuous provision of information by professional organizations and use of mobile devices as key means to access information by pharmacists.

Radio Signal Sensing and Signal Processing to Monitor Behavioral Symptoms in Dementia: A Case Study.

OBJECTIVES: Alzheimer's Disease (AD)-related behavioral symptoms (i.e. agitation and/or pacing) develop in nearly 90% of AD patients. In this N = 1 study, we provide proof-of-concept of detecting changes in movement patterns that may reflect underlying behavioral symptoms using a highly novel radio sensor and identifying environmental triggers. METHODS: The Emerald device is a Wi-Fi-like box without on-body sensors, which emits and processes radio-waves to infer patient movement, spatial location and activity. It was installed for 70 days in the room of patient 'E', exhibiting agitated behaviors. RESULTS: Daily motion episode aggregation revealed motor activity fluctuation throughout the data collection period which was associated with potential socio-environmental triggers. We did not detect any adverse events attributable to the use of the device. CONCLUSION: This N-of-1 study suggests the Emerald device is feasible to use and can potentially yield actionable data regarding behavioral symptom management. No active or potential device risks were encountered.