METHODS: We systematically searched MEDLINE, Embase, and Cochrane databases until November 2022 for randomized controlled PEP prophylaxis trials. We invited authors to share individual patient data, including PEP risk profile and prophylaxes used. PEP incidence rates for different prophylaxis were calculated. Efficacy was compared using multilevel logistic regression and expressed as relative risk (RR). Subgroup analysis evaluated the role of patient and ERCP-related risk factors in developing PEP.
RESULTS: Data from 11 studies, including 6430 patients, were analyzed. After adjusting for risk factors, rectal NSAIDs (RR 0.69, 95%CI 0.54-0.88) and peri-procedural high-volume intravenous fluid (IVF) (RR 0.40, 95%CI 0.21-0.79) were effective in reducing PEP incidence, while no benefit was noted with pancreatic duct (PD) stents (RR 1.25, 95%CI 0.91-1.73). In patients receiving rectal NSAIDs (n = 2617), difficult cannulation (RR 1.99, 1.45-2.73), contrast injection into the pancreatic duct (PD) (RR2.37, 1.68-3.32), and prior history of PEP (RR 1.90, 1.06-3.41) were associated with increased PEP risk.
CONCLUSION: This IPDMA confirms that rectal NSAIDs and peri-procedural IVF are effective PEP prophylactic strategies. Further studies focusing on combination therapy or the development of personalized PEP risk calculators are needed to improve prophylactic strategies.
METHODS: A survey was distributed through the friends of United European Gastroenterology (UEG) Young Talent Group network to physicians working in a UEG member or associated states who regularly performed ERCPs.
RESULTS: Of 1035 respondents from 35 countries, 649 were eligible for analysis: 228 trainees, 225 trainers, and 196 individuals who regularly performed ERCP but were neither trainees nor trainers. The mean age was 43 years, with 72.1% identifying as male, 27.6% as female, and 0.3% as non-binary. The majority (80.1%) agreed that a structured training regimen is desirable. However, only 13.7% of trainees and 28.4% of trainers reported having such a structured program in their institutions. Most respondents (79.7%) supported the concept of concentrating training in centers meeting specific quality metrics, with 64.1% suggesting a threshold of 200 annual ERCPs as a prerequisite. This threshold revealed that 36.4% of trainees pursued training in lower-volume centers performing <200 ERCPs annually. As many as 70.1% of trainees performed <50 annual ERCPs, whereas only 5.0% of trainers performed <50 ERCPs annually. A low individual trainee caseload (<50 ERCPs annually) was more common in lower-volume centers than in higher-volume centers (82.9% vs. 63.4%).
CONCLUSIONS: The first pan-European survey investigating ERCP training conditions reveals strong support for structured training and the concentration of training efforts within centers meeting specific quality metrics. Furthermore, this survey exposes the low availability of structured training programs with many trainees practicing at lower-volume centers and 71% of all trainees having little hands-on exposure. These data should motivate to standardize ERCP training conditions further and ultimately improve patient care throughout Europe.
OBJECTIVES: This study aimed to assess the feasibility and acceptability of integrating clinical pharmacists into the multidisciplinary team (MDT) to manage cancer pain and assess preliminary outcomes in cancer patients receiving pain treatment. This pilot study was undertaken to inform a future definitive randomized controlled trial (RCT).
METHODS: The protocol was registered with ClinicalTrials.gov (NCT05021393). The PharmaCAP trial was conducted in two oncology centers in Nepal, where patients were randomly enrolled into usual care (UC) or an intervention group (PharmaCAP). The latter received a clinical pharmacist-led medication review, which involved a comprehensive assessment of the patient's current medications, identification of potential drug-related problems, and personalized recommendations for optimizing pain management. This was accompanied by pain assessment, education and counseling on pain management strategies. Baseline and 4-weeks post-intervention assessments measured primary outcomes, i.e., feasibility metrics (recruitment of the patients, retention of patients, patient satisfaction). Secondary outcomes included pain intensity, health-related QoL, anxiety, depression, barriers to pain management, and medication adherence at 4 weeks.
RESULTS: Out of 140 screened patients, 108 were evaluated for eligibility, with 16 opting out primarily due to lack of interest (n = 11) and communication barriers (n = 5). A total of ninety-two participants with cancer pain were randomized into two groups, with 91 patients successfully recruited and 85 (93.4%) completing 4 weeks post-intervention assessment). Completion rates for the UC and PharmaCAP groups were 91.3% and 93.4%, respectively. The primary feasibility outcomes were positive: 100% of patients found random allocation acceptable. Retention rates were high, with 91.3% in the UC group and 93.4% in the PharmaCAP group, despite a few dropouts due to being unreachable, COVID-related issues, and changes in treatment centers. No evidence of contamination between groups was found, as participants did not discuss interventions or influence each other's attitudes, ensuring effective isolation of interventions The PharmaCAP intervention showed significant improvement in QoL (P
METHODS: A systematic search was conducted through Embase, PubMed, and Web of Science. International BMI cut-offs were employed to define underweight, overweight and obesity. The primary outcome was all-cause mortality, and the secondary outcome was respiratory and cardiovascular mortality.
RESULTS: 120 studies encompassed a total of 1 053 272 patients. Underweight status was associated with an increased risk of mortality, while overweight and obesity were linked to a reduced risk of mortality. A nonlinear U-shaped relationship was observed between BMI and all-cause mortality, respiratory mortality and cardiovascular mortality. Notably, an inflection point was identified at BMI 28.75 kg·m-2 (relative risk 0.83, 95% CI 0.80-0.86), 30.25 kg·m-2 (relative risk 0.51, 95% CI 0.40-0.65) and 27.5 kg·m-2 (relative risk 0.76, 95% CI 0.64-0.91) for all-cause, respiratory and cardiovascular mortality, respectively, and beyond which the protective effect began to diminish.
CONCLUSION: This study augments the existing body of evidence by confirming a U-shaped relationship between BMI and mortality in COPD patients. It underscores the heightened influence of BMI on respiratory and cardiovascular mortality compared to all-cause mortality. The protective effect of BMI was lost when BMI values exceeded 35.25 kg·m-2, 35 kg·m-2 and 31 kg·m-2 for all-cause, respiratory and cardiovascular mortality, respectively.
MATERIALS AND METHODS: The isolate was grown in a bioreactor, inactivated using binary ethyleneimine, adjuvanted with Montanide 71VG, and injected into day-old broiler chickens either with or without booster groups. The following parameters were measured: T lymphocyte profile in the liver, spleen, and thymus; FAdV antibody titer; clinical symptoms; gross and histological alterations in the liver, spleen, and thymus; virus copy number in the liver and cloacal shedding.
RESULTS: Compared to the unchallenged control group, booster (BG), and non-booster (NBG), the challenged control group (CCG) had a larger liver: body weight (BW) ratio, milder clinical signs, gross lesions, and histological alterations. They also had a lower BW. At 7, 21, 35, and 42 days post-inoculation (dpi), the NBG and BG exhibited higher antibody levels than the UCG. At 35 dpi, challenged BG and NBG produced more antibodies than CCG. In BG and NBG, T cells were stimulated in the spleen, thymus, and liver. At 35 and 42 dpi, the challenged BG and NBG showed significantly decreased viral copy numbers in the liver and shedding, respectively, along with increased lymphocyte counts.
CONCLUSION: The inactivated UPM11142P5B1 with Montanide 71VG could be a vaccine against FAdV 8b infections in chickens.
SYSTEMATIC REVIEW REGISTRATION: http://www.crd.york.ac.uk/PROSPERO, identifier (ID: CRD42023455192).
METHODS: A cross-sectional study was conducted from April to June 2024 using a questionnaire-based approach. The questionnaire, developed in English, was uploaded to Google Forms and distributed through social networking platforms. It consisted of four sections: demographic information, pharmacists' experiences with gabapentin abusers, strategies to limit access to gabapentin, and perceptions of gabapentin abuse, which were assessed using a 5-point Likert scale. A Chi-square test was employed to analyze the association between categorical variables.
RESULTS: The study included 209 pharmacists (median age 29.0 years, IQR 8.0 years). Concerning gabapentin, 72.7% of pharmacists received requests to sell it in the past 6 months. Of these, about 75.7% encountered suspected gabapentin abusers, noting behavioural changes (95.9%), frequent refill requests (90.4%), and inconsistent medical histories (87.8%) as key indicators. Most suspected abusers were male (81.7%) and aged 21-30 years (74.8%).Common reasons cited by suspected abusers for requesting gabapentin included neuropathic pain (93.0%), low back pain (89.6%), and mood instability (73.0%). Pharmacists perceived an increase in gabapentin abuse (74.5%) and expressed a need for additional training (83.3%). Additionally, 83.7% recognised their pivotal role in identifying and addressing gabapentin abuse. Finally, significant associations were found between working in chain pharmacies and receiving gabapentin requests (χ² = 9.159, p = 0.002).
CONCLUSION: Pharmacists have an important role in detecting gabapentin abuse which necessitates adequate education. Pharmacists have concerns regarding this issue and believe stricter regulations are needed.
OBJECTIVE OF STUDY: The study assessed digital pharmacy applications in India using the Mobile App Rating Scale (MARS) on Android and iOS devices, aiming to evaluate their quality.
METHODS: An investigation examined the digital pharmacy applications in India that were accessible via the Android Market and App Store. The applications were assessed by two researchers using the MARS questionnaire, a tool that evaluates 23 variables categorized into five domains: Engagement, Functionality, Aesthetics, Information, and Subjective Quality. The grading system spanned from one to five for every category.
RESULTS: A Google Play Store and App Store investigation revealed 40 online pharmacy apps in India, with 13 rejected. Seven were non-English language-related apps and seven were not downloaded. Thirteen were chosen and evaluated using the MARS Scale. The MARS demonstrated significant positive associations across its components, namely Engagement, Functionality, Aesthetics, and Information. Specifically, greater levels of user functionality were shown to be indicative of superior app aesthetics and engagement. The mean rating of the 13 apps fell between the range of 3.11 to 4.32 on a 5-point scale.
CONCLUSION: This is the first study to utilize the MARS scale to assess the efficacy of online pharmacy applications in India. This research enhanced the functionality and quality of various online pharmacy applications utilized in India.