MATERIALS AND METHODS: A trial-based cost-effectiveness study with a 6-month time horizon was conducted. Ninety-one participants (intervention, n = 46; usual care, n = 45) across 13 community pharmacies were included. The intervention group received in-depth counselling from pharmacists, in-app prediabetes education modules and peer support, while the usual care group received counselling based on pharmacists' usual practice. The primary outcome was quality-adjusted life years (QALY). Incremental cost-effectiveness ratios (ICER) per QALY gained of the intervention were compared with usual care from healthcare and societal perspectives. Non-parametric bootstrapping was used to examine uncertainty.
RESULTS: At 6months, the QALY achieved was 0.467 (95% CI 0.456 to 0.479) in the intervention group and 0.466 (95% CI 0.451 to 0.482) in the usual care group, resulting in a net gain of 0.005 QALY (95% CI -0.017 to 0.026) in the intervention group. The incremental healthcare and societal costs were US$6.10 (95% CI $5.33 to $6.88) and $10.69 (95% CI $6.03 to $15.35), respectively. From a healthcare perspective, the ICER per QALY gained was $1354, with a probability of 69.2% being cost-effective, while the corresponding figures were $2371 and 67.7% from a societal perspective. Results were below the willingness-to-pay threshold at $11 845 and were robust to sensitivity analyses.
CONCLUSION: A community pharmacy-based and digital health-supported lifestyle intervention to manage prediabetes may be cost-effective compared with usual care in Malaysia over a 6-month period.
METHODS: The scope of this post-hoc study was subgroup analysis by race to compare the efficacy and safety of SB12 and ECU in PNH patients in the Asian and Non-Asian subgroups of the Phase III study.
RESULTS: Results including lactate dehydrogenase (LDH), number of units of packed red blood cells and safety as primary and secondary endpoints demonstrated comparable efficacy and safety of SB12 and ECU in Asian and Non-Asian PNH patients, in line with the study results in the overall population. In addition, transfusion avoidance (68.1% for SB12 vs. 72.9% for ECU, p-value of 0.4492) and hemoglobin stabilization (SB12-ECU: 6.3%, 95% confidence interval [CI] [-21.5, 34.1] and SB12-ECU: 2.5%, 95% CI [-24.8, 29.8] using stringent criteria) as post-hoc endpoints were not substantially different between SB12 and ECU treatment groups in the overall population as well as in Asians and Non-Asians.
CONCLUSION: In conclusion, this subgroup analysis by race (Asians and Non-Asians) supports comparable efficacy and safety between SB12 and reference eculizumab in global PNH patients including no difference in transfusion avoidance effect.
METHODS: This qualitative study was conducted in seven community pharmacies in Depok, an urban area near Jakarta. Data were collected in 2023 using triangulation methods: semi-structured interviews, direct observations, and simulated patient interactions. Verbatim transcriptions and thematic analysis were performed using NVivo®12 to analyse the findings.
RESULTS: Four identified themes were the structures, daily practices, challenges, and enablers of telepharmacy services. The scope of telepharmacy services consisted of dispensing medicines, patient education, and providing drug information through mobile applications by pharmacy electronic system organisers (PSEF) or social media platforms. Challenges in daily practice revealed gaps in traditional pharmaceutical service guidelines, including systems interoperability, effective communication among pharmacists-physician-patients, and the need for standards specific to digital pharmaceutical services. Common problems in telepharmacy were uncertain medicine availability, unclear e-prescription validity, limited pharmacist-physician collaboration, and impeded patient education, particularly in services provided through PSEF applications. On the other hand, the availability of digital technologies was seen as beneficial, highlighting the necessity for predefined standardised facilities to ensure the quality of telepharmacy services.
CONCLUSION: While traditional pharmaceutical service standards can be applied to evaluate telepharmacy practices, specific challenges must be explicitly addressed within a dedicated telepharmacy standard to ensure patient safety and service quality.
METHODS: Our prospective, multicenter study enrolled 704 adult patients from 21 centers who underwent FURS with FANS between August 2023 and October 2024. IO-SFS was categorized into three groups: (1) 100% SFR (no dust or fragments), (2) only dust remaining, and (3) both dust and fragments remaining. PO-SFS was assessed via 2 mm non-contrast computed tomography (NCCT) at 30 days and categorized into four grades: Grade A (100% stone-free), Grade B (single ≤ 2 mm residual fragment), Grade C (single 2.1-4 mm), and Grade D (multiple or any > 4 mm). Primary outcome was correlation between intraoperative and postoperative 100% SFS. Secondary outcomes included perioperative complications, reintervention rates, and predictors of residual fragments and perioperative complications.
RESULTS: IO-SFS reported 100% SFR in 395 cases. Postoperative NCCT confirmed a significantly higher SFS (Grade A + B) in this group (99%) compared to 95.8% in the dust only group and 61.1% in the dust and fragments group (p
METHOD: This study developed a conceptual framework based on the "Future Triangle" (FT) and the "Health Systems Governance" (HSG) models. This framework delineates the characteristics associated with the 'pulls on the future' for desired and intelligent PHC, as identified by a panel of experts. Additionally, the 'weights of the past'-referring to the challenges faced by Iran's PHC system in utilizing AI-, and the 'push of the present'-which captures the impacts of AI implementation in global primary care settings-were extracted through a review of relevant literature. The integration and analysis of the collected evidence facilitated the formulation of a range of potential future scenarios, including both optimistic and pessimistic scenarios.
FINDINGS: The interaction between the three elements of the FT will shape the future states of Iran's PHC, whether optimistic or pessimistic. Building an optimistic scenario for an AI-driven PHC system necessitates addressing past challenges, including deficiencies in the referral and family doctor systems, the absence of evidence-based decision-making, neglect of essential community health needs, fragmented service delivery, high provider workload, and inadequate follow-up on the health status of service recipients. Consideration must also be given to the current impacts of AI in primary care, including comprehensive, coordinated, and need-based service delivery with systematic and integrated monitoring, quality improvement, early disease prevention, precise diagnosis, and effective treatment. Furthermore, fostering a shared vision among stakeholders by defining and advocating for a future system characterized by foresight, resilience, agility, adaptability, and collaboration is essential.
CONCLUSION: Envisioning potential future states requires a balanced consideration of the influence of past, present, and future, recognizing the dual potential of AI to drive either positive or negative outcomes. Achieving the optimistic future or the "utopia of intelligent PHC" and avoiding the pessimistic future or the "dystopia of intelligent PHC" requires coherent planning, attention to the tripartite considerations of the future, past, and present, and a clear understanding of the roles, expectations, and needs of stakeholders.
METHODS: This study aimed to investigate the association among physical activity (PA), functional fitness, and cognitive function in community-dwelling older adults, and to examine whether functional fitness mediates this association. This study utilized a cross-sectional design, encompassing 224 participants aged 65 or above, with 41.07% male and 58.93% female. The data were collected in 2023 using the Mini-Mental State Examination, Physical Activity Scale for the Elderly, and Senior Fitness Test. Pearson correlation analysis was conducted to assess associations among the variables, and mediation analysis was performed using the PROCESS macro for SPSS.
RESULTS: The results indicated that PA had a moderate positive correlation with cognitive function (r = 0.437, p
OBJECTIVES: To examine the long-term gastrointestinal symptom progression and psychological comorbidities in patients with post-COVID-19 DGBI, patients with pre-existing IBS/FD and non-DGBI controls.
METHODS: This post hoc analysis of a prospective multicenter cohort study reviewed patient charts for demographic data and medical history. Participants completed the Gastrointestinal Symptom Rating Scale at four time points: baseline, 1, 6, and 12 months, and the Hospital Anxiety and Depression Scale at 6 and 12 months. The cohort was divided into three groups: (1) post-COVID-19 DGBIs (2) non-DGBI, and (3) pre-existing IBS/FD, with the post-COVID-19 DGBIs group compared to the latter two control groups.
RESULTS: Among 599 eligible patients, 27 (4.5%) were identified as post-COVID-19 DGBI. This group experienced worsening abdominal pain, hunger pain, heartburn, and acid regurgitation, unlike symptom improvement or stability in non-DGBI controls (p
AIM: What types of Transnational Medical Education programmes can be identified from the international literature? What are the strengths and weaknesses of these programmes and do they prepare students for international practice?
METHODS: This review was based on the PRISMA-Guidelines for systematic reviews. We searched five electronic databases: MEDLINE, EMBASE, CINAHL, WEB of Science and ERIC. No date or language restrictions were placed on the inclusion criteria. Data extraction was completed by two independent reviewers. Quality appraisal was carried out using the Mixed Methods Appraisal Tool (MMAT), and a narrative synthesis of the included papers was conducted.
RESULTS: Our literature search identified 12 studies. From the included studies we were able to identify three types of Transnational Medical Education Programme, and a number of strengths and weaknesses of these programmes. Strengths were: increasing medical workforce capacity, enhancing the quality of education locally, promoting intercultural competence and increasing exposure to new ways of working (enhanced communication skills, shared decision-making, experience of multidisciplinary teamwork and patient-centeredness). Weaknesses were: potential curriculum misalignment within the context of clinical practice, language barriers and encountering differences in hierarchical systems, shared decision making and patient-centredness all of which impact preparation for practice.
CONCLUSION: Transnational medical education programmes address shortages within the medical workforce by creating additional training opportunities. They can also drive up the quality of medical education locally. There is, however, a potential mismatch between the curriculum and the place of practice which can impact upon graduates' preparation for professional practice.