METHODS: Using a narrative qualitative approach, we conducted in-depth one-on-one interviews with six pharmacists, delving into their personal experiences with topics such as medicine classification and the broader systems for medication provision. The collected narratives were analysed through a rigorous thematic analysis, following the framework established by Braun & Clarke.
RESULTS: Five themes emerged from the data: nuances of Brunei Darussalam's medicine dispensing landscape across both public and private sectors; accessibility and regulatory framework of medicines both in Brunei Darussalam and abroad; prospective implementations to enhance the current system; and the evolving role and expectations of pharmacists in the current healthcare environment. Notably, a significant contribution of this study was the illumination of the differential perspectives between pharmacists operating in governmental versus private contexts.
CONCLUSION: This study sheds light on the previously under-explored domain of Brunei Darussalam's medicine control governance and medicine dispensing system. By drawing from the first-hand experiences of practicing pharmacists, it offers actionable insights that could guide future policy developments, optimise medicine dispensation and regulation, and shape the evolving role of pharmacists in Brunei Darussalam.
METHODS: A qualitative study was conducted among eleven asthma patients and twelve community pharmacists using semi-structured individual interviews. All interviews were audio-recorded and transcribed verbatim and then analyzed by thematic analysis. The findings were reported using the COREQ checklist.
RESULTS: Thematic analysis yielded eight major themes, (1) perceptions and understanding of good asthma control; (2) perceptions and experience towards asthma follow-up review; (3) perceptions of SABA's reliance; (4) practices towards the proper use of inhalers; (5) over-the-counter availability of SABA inhalers; (6) provision of pharmacists in SABA use assessment; (7) patients-healthcare professionals communication; and (8) recommendations for policymakers.
CONCLUSION: Most asthma patients and community pharmacists agreed that good asthma control was associated with reduced SABA usage and minimum asthma symptoms. The majority of patients claimed that visiting physicians for asthma follow-up reviews was unnecessary. Moreover, community pharmacists have raised concerns regarding patients' reliance on SABA inhalers due to the immediate relief effects, however, the majority of interviewed patients claimed that they did not rely on SABA inhalers. Additionally, community pharmacists were generally concerned about the frequency, dosage, and techniques using SABA inhalers. These concerns need to be addressed to improve the safe use of SABA inhalers. Language barriers, health literacy, long waiting times, and public education were the most important believed determinants of the safe use of SABA inhalers.
OBJECTIVES: This systematic review aimed to assess the impact of pharmacist-led medication reviews among HD patients, identify the most prevalent types of DRPs, and explore the factors associated with these problems.
METHODS: A systematic search was conducted across databases such as Medline via PubMed, Science Direct, Google Scholar, and EBSCOHost, for studies published from January 2012 to July 2023. Studies included were those focusing on pharmacist interventions in HD patients. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of selected studies.
RESULTS: After screening 343 articles, 10 studies (involving 1342 HD patients) were included. Nine studies were rated as high quality, and one as fair quality. The studies predominantly used prospective designs. A total of 4511 DRPs were identified, with suboptimal drug treatment, non-adherence to medications, and drug use without indication being the most common issues. Pharmacist interventions led to the resolution or reduction of DRPs, shorter hospital stays, improvement in laboratory outcomes, better quality of life (QoL), and enhanced patient understanding. However, interventions had minimal or no significant impact on reducing unplanned admissions, mortality rates, or improving medication adherence. The reduction in healthcare utilisation costs was inconsistent across studies.
CONCLUSION: Pharmacist-led medication reviews were effective in resolving DRPs and improving clinical outcomes in HD patients, such as quality of life and lab values. However, their impact on healthcare utilisation and mortality remains inconclusive. Further research with longer follow-up is needed to assess the long-term economic outcomes of these interventions.
METHODS: For a subsample of 178 children from the Canadian CHILD Cohort Study, gut microbiota of fecal samples collected at 3-4 months and 12 months was profiled using 16S rRNA sequencing. Gut bacterial metabolites levels and SIgA level were measured by nuclear magnetic resonance (NMR) based metabolomics and SIgA enzyme-linked immunosorbent assay at 3-4 months, respectively. Bayley-III Scale of Infant Development was assessed at 12 and 24 months. We evaluated direct relationships in multiple linear regression models and putative causal relationships in statistical mediation models.
RESULTS: Propionate and butyrate levels at 3-4 months were associated with decreased Bayley cognitive score at 24 months (p-values: 0.01 and 0.02, respectively) in adjusted multiple linear regression models, but when we investigated an indirect relationship mediated by decreased SIgA level at 3-4 months, it did not reach statistical significance (p-values: 0.18 and 0.20, respectively). Lactate level at 3-4 months was associated with increased Bayley cognitive score at 24 months in adjusted multiple linear regression models (p-value: 0.01), but the statistical model mediated by increased SIgA level at 3-4 months did not reach statistical significance neither (p-value: 0.20).
CONCLUSIONS: Our study contributes to growing evidence that neurodevelopment is influenced by the infant gut microbiota and that it might involve SIgA level, but larger studies are required.
METHODS: We have collected the brains of African green monkeys during multiple Nipah virus, Bangladesh studies, resulting in 14 brains with Nipah virus-associated lesions.
RESULTS: The lesions seen in the brain of African green monkeys infected with Nipah virus, Bangladesh were very similar to those observed in humans with Nipah virus, Malaysia infection. We observed viral RNA and antigen within neurons and endothelial cells, within encephalitis foci and in uninflamed portions of the central nervous system (CNS). CD8+ T cells had a consistently high prevalence in CNS lesions. We developed a UNet model for quantifying and visualizing inflammation in the brain in a high-throughput and unbiased manner. While CD8+ T cells had a consistently high prevalence in CNS lesions, the model revealed that CD68+ cells were numerically the immune cell with the highest prevalence in the CNS of Nipah virus-infected animals.
CONCLUSIONS: Our study provides an in-depth analysis on Nipah virus infection in the brains of primates, and similarities between lesions in patients and the animals in our study validate this model.
METHODS: This retrospective study examined 74 limb segments from 45 patients with OI who underwent intramedullary rodding and adjunctive plating from 2008 to 2022. Criteria for inclusion comprised surgical treatment followed by a minimum of 2 years of follow-up or complication before that time point. The need for adjunctive plating arose from inadequate fixation, rotational instability, and persistent cortical gaps with intramedullary rodding alone. Medical records and follow-up radiographs were reviewed to assess the healing of the target lesion and any complications.
RESULTS: The study encompassed 30 males and 15 females, ranging in age from 4 to 38 years, with 51 femoral and 23 tibial segments receiving treatment. Union was successfully achieved in 63 cases (85.3%), with an average union time of 14.4 months. Plates were subsequently removed in 62 cases after an average duration of 18.0 months. Before union, 11 revision surgeries were performed in 4 peri-implant fractures, 1 screw pull-out, and 6 failure of union. One sustained peri-implant fracture after the union. Following the removal of plates, complications included 10 refractures at screw sites, 3 progressive angulations at the previously targeted lesions, and 1 osteomyelitis. Kaplan-Meier analysis revealed that half of the refractures occurred within 1.8 years postplate removal. The overall complication showed borderline significance ( P =0.056) among age groups. All the plate-related complications occurred at the diaphyseal, unicortical screws.
CONCLUSIONS: Plate fixation, when used as an adjunct to intramedullary rodding, effectively stabilizes limbs in OI patients when intramedullary rods alone are inadequate. Nevertheless, given the significant risks associated with plate-related complications, adjunctive plating should be employed selectively only in instances where the union is unlikely to be achieved with intramedullary rodding alone.
LEVEL OF EVIDENCE: Level IV-case series.
METHODS: International, prospective, noninterventional registry of the clinical practice of the European gastroenterologists. Data were collected and quality reviewed until March 2021 at AEG-REDCap. The effectiveness was evaluated by modified intention-to-treat analysis, differentiating by geographic areas. Adverse events (AEs) were categorized as mild, moderate, and severe.
RESULTS: Overall, 36,699 treatments were recorded, where 8,233 (22%) were prescribed with probiotics. Probiotics use was associated with higher effectiveness in the overall analysis (odds ratio [OR] 1.631, 95% confidence interval [CI] 1.456-1.828), as well as in triple (OR 1.702, 95% CI 1.403-2.065), quadruple (OR 1.383, 95% CI 0.996-1.920), bismuth quadruple (OR 1.248, 95% CI 1.003-1.554), and sequential therapies (OR 3.690, 95% CI 2.686-5.069). Lactobacillus genus was associated with a higher therapy effectiveness in Eastern Europe when triple (OR 2.625, 95% CI 1.911-3.606) and bismuth quadruple (OR 1.587, 95% CI 1.117-2.254) first-line therapies were prescribed. In Central Europe, the use of probiotics was associated with a decrease in both the overall incidence of AEs (OR 0.656, 95% CI 0.516-0.888) and severe AEs (OR 0.312, 95% CI 0.217-0.449). Bifidobacterium genus was associated with lower overall (OR 0.725, 95% CI 0.592-0.888) and severe (OR 0.254, 95% CI 0.185-0.347) AEs, and Saccharomyces was associated with reduced overall (OR 0.54, 95% CI 0.32-0.91) and severe (OR 0.257, 95% CI 0.123-0.536) AEs under quadruple-bismuth regimen.
DISCUSSION: In Europe, the use of probiotics was associated with higher effectiveness and safety of H. pylori eradication therapy. Lactobacillus improved treatment effectiveness, whereas Bifidobacterium and Saccharomyces were associated with a better safety profile.
METHODS: This retrospective observational study included all VEM cases performed in the University Malaya Medical Centre, Kuala Lumpur, Malaysia from 1st January 2011 to 30th April 2024, with SPECT as part of the pre-surgical evaluation.
RESULTS: A total of 189 cases were included. The mean age was 33.3 years old (range 9-68), and 105 (55.6 %) were male. The mean baseline seizure frequency before VEM was 21.8 per month. The mean number of seizures recorded during a 48-hour VEM was 10.9. A total of 44 (23.3 %) patients had ictal SPECT with a single SPECT session. Ictal SPECT was significantly associated with a higher number of seizures during 48-hour VEM (31.5 ± 58.7 vs 4.4 ± 6.3, p