Drinkable in situ-forming tough hydrogels for gastrointestinal therapeutics

Nature Materials, Год журнала: 2024, Номер 23(9), С. 1292 - 1299

Опубликована: Фев. 27, 2024

Pills are a cornerstone of medicine but can be challenging to swallow. While liquid formulations easier ingest, they lack the capacity localize therapeutics with excipients nor act as controlled release devices. Here we describe drug based on in situ-forming tough (LIFT) hydrogels that bridge advantages solid and dosage forms. LIFT form directly stomach through sequential ingestion crosslinker solution calcium dithiol crosslinkers, followed by drug-containing polymer alginate four-arm poly(ethylene glycol)-maleimide. We show robustly stomachs live rats pigs, mechanically tough, biocompatible safely cleared after 24 h. deliver total dose comparable unencapsulated manner, protect encapsulated therapeutic enzymes bacteria from gastric acid-mediated deactivation. Overall, may expand access advanced for patients difficulty swallowing.

Язык: Английский

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Cumulative Update of a Systematic Overview Evaluating Interventions Addressing Polypharmacy

JAMA Network Open, Год журнала: 2024, Номер 7(1), С. e2350963 - e2350963

Опубликована: Янв. 10, 2024

Importance Polypharmacy is associated with mortality, falls, hospitalizations, and functional cognitive decline. The study of polypharmacy-related interventions has increased substantially, prompting the need for an updated, more focused systematic overview. Objective To systematically evaluate summarize evidence across multiple reviews (SRs) examining addressing polypharmacy. Evidence Review A search was conducted MEDLINE, Cochrane Database Systematic Reviews, Abstracts Reviews Effects articles published from January 2017-October 2022, as well those identified in a previous overview (January 2004-February 2017). were included regardless design, setting, or outcome. summarized by 4 categories: (1) medication-related process outcomes (eg, potentially inappropriate medication [PIM] potential prescribing omission reductions), (2) clinical outcomes, (3) health care use economic (4) acceptability intervention. Findings Fourteen SRs (3 overview), 7 which meta-analyses, representing 179 unique studies. Nine examined (low to very low quality). using pooled analyses found significant reductions number PIMs, omissions, total medications, improvements appropriateness. Twelve (very moderate Five mortality; all mortality meta-analyses null, but studies longer follow-up periods greater mortality. falls incidence; results predominantly null save meta-analysis PIMs discontinued. Of 8 quality life, most (7) effects. Ten hospitalizations readmissions quality) emergency department visits One SR among higher-intensity face-to-face patient components. Another effect. without readmissions, had results. Two visits. quality), finding wide variation adoption interventions. Conclusions Relevance This updated noted little association between reduced important outcomes. More needed regarding are useful populations would benefit most.

Язык: Английский

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The effect of polypharmacy on healthcare services utilization in older adults with comorbidities: a retrospective cohort study

BMC Primary Care, Год журнала: 2023, Номер 24(1)

Опубликована: Май 26, 2023

Abstract Background Older adults are more prone to increasing comorbidities and polypharmacy. Polypharmacy is associated with inappropriate prescribing an increased risk of adverse effects. This study examined the effect polypharmacy in older on healthcare services utilization (HSU). It also explored impact different drug classes including psychotropic, antihypertensive, antidiabetic HSU. Methods a retrospective cohort study. Community-dwelling aged ≥ 65 years were selected from primary care patient database ambulatory clinics Department Family Medicine at American University Beirut Medical Center. Concomitant use 5 or prescription medications was considered Demographics, Charlson Comorbidity index (CCI), HSU outcomes, rate all-cause emergency department (ED) visits, hospitalization, ED visits for pneumonia, hospitalization mortality collected. Binomial logistic regression models used predict rates outcomes. Results A total 496 patients analyzed. Comorbidities present all patients, 22.8% (113) having mild moderate comorbidity 77.2% (383) severe comorbidity. Patients likely have compared no (72.3% vs. 27.7%, p = 0.001). visit causes as without (40.6% 31.4%, 0.05), had significantly higher (adjusted odds ratio aOR 1.66, 95 CI 1.08–2.56, 0.022). psychotropic be hospitalized due pneumonia (crude cOR 2.37, 1.03–5.46, 0.043), Pneumonia (cOR 2.31, 1.00–5.31, 0.049). The association lost significance after adjustment. Conclusions prevalence amongst geriatric population increase As such, frequent medication revisions holistic, multi-disciplinary approach needed.

Язык: Английский

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An Evidence-Based Update on Anticholinergic Use for Drug-Induced Movement Disorders

CNS Drugs, Год журнала: 2024, Номер 38(4), С. 239 - 254

Опубликована: Март 19, 2024

Drug-induced movement disorders (DIMDs) are associated with use of dopamine receptor blocking agents (DRBAs), including antipsychotics. The most common forms drug-induced parkinsonism (DIP), dystonia, akathisia, and tardive dyskinesia (TD). Although rare, neuroleptic malignant syndrome (NMS) is a potentially life-threatening consequence DRBA exposure. Recommendations for anticholinergic in patients DIMDs were developed on the basis roundtable discussion healthcare professionals extensive expertise DIMD management, along comprehensive literature review. agreed that "extrapyramidal symptoms" non-specific term encompasses range abnormal movements. As such, it contributes to misconception all can be treated same way, leading misuse overprescribing anticholinergics. neurobiologically clinically distinct, different treatment paradigms varying levels evidence use. Whereas indicates anticholinergics effective DIP they not recommended TD, or NMS; nor supported preventing except individuals at high risk acute dystonia. Anticholinergics may induce serious peripheral adverse effects (e.g., urinary retention) central impaired cognition), which highly concerning especially older adults. Appropriate therefore requires careful consideration efficacy supportive but TD) risks events. If used, medications should prescribed lowest dose limited periods time. When discontinued, tapered gradually.

Язык: Английский

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Risk of Polypharmacy and Its Outcome in Terms of Drug Interaction in an Elderly Population: A Retrospective Cross-Sectional Study

Journal of Clinical Medicine, Год журнала: 2023, Номер 12(12), С. 3960 - 3960

Опубликована: Июнь 10, 2023

The simultaneous use of multiple drugs-termed 'polypharmacy'-is often required to manage physiological and biological changes the interplay between chronic disorders that are expected increase in association with ageing. However, by increasing number medications consumed, risk undesirable medication reactions drug interactions also increases exponentially. Hence, knowledge prevalence polypharmacy potentially serious drug-drug (DDIs) elderly patients should be considered a key topic interest for public health care professionals. Methods: Prescription demographic data were collected from electronic files who aged ≥ 65 years attended Al-Noor Hospital Makkah, Saudi Arabia, 2015 2022. Lexicomp® DDI-checking platform was used evaluate patients' regimens any potential interactions. Results: A total 259 included study. among cohort 97.2%: 16 (6.2%) had minor polypharmacy, 35 (13.5%) moderate 201 (77.6%) major polypharmacy. Of taking two or more simultaneously, 221 (85.3%) at least one DDI (pDDI). most frequently reported pDDI under category X avoided interaction clopidogrel esomeprazole found 23 (18%). D therapeutic modification enoxaparin aspirin, which 28 (12%). Conclusions: It is necessary take several simultaneously diseases. Clinicians distinguish suitable, appropriate unsuitable, inappropriate this criterion closely examined when establishing plan.

Язык: Английский

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Prevalence and Appropriateness of Polypharmacy in Older Adults with Inflammatory Bowel Diseases

Digestive Diseases and Sciences, Год журнала: 2024, Номер 69(3), С. 766 - 774

Опубликована: Янв. 25, 2024

Язык: Английский

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Aging and the Prevalence of Polypharmacy and Hyper-Polypharmacy Among Older Adults in South Korea: A National Retrospective Study During 2010–2019

Frontiers in Pharmacology, Год журнала: 2022, Номер 13

Опубликована: Май 9, 2022

Background: Polypharmacy has become a global health problem and is associated with adverse outcomes in the elderly. This study evaluated prevalence of polypharmacy hyper-polypharmacy elderly patients South Korea during 2010–2019. Methods: We analyzed outpatient care persons aged ≥65 years covered by National Health Insurance (NHI) using NHI claims data from 2010 to 2019. was defined as use ≥5 medications, ≥10 we examined them over periods ≥90 days ≥180 days. The average annual percent change (AAPC) calculated Joinpoint statistical software. Results: among medication decreased 42.5% 41.8% 2019, for increased 10.4% 14.4%. 37.8% 38.1% 6.4% 9.4%. steadily patients, AAPCs 3.7 4.5, respectively. Conclusion: remained stably high, rates about 42 38%, respectively, past 10 Korea. Therefore, strategies address need be implemented. Further research also required identify clinical (including mortality risks) polypharmacy.

Язык: Английский

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Decision-support systems for managing polypharmacy in the elderly: A scoping review

Journal of Biomedical Informatics, Год журнала: 2022, Номер 130, С. 104074 - 104074

Опубликована: Апрель 23, 2022

Polypharmacy, the consuming of more than five drugs, is a public health problem. It can lead to many interactions and adverse drug reactions very expensive. Therapeutic guidelines for managing polypharmacy in elderly have been issued, but are highly complex, limiting their use. Decision-support systems therefore developed automate execution these guidelines, or provide information about drugs adapted context polypharmacy. These differ widely terms technical design, knowledge sources evaluation methods. We present here scoping review electronic supporting management, by healthcare providers, patients. Most existing reviews focused mainly on results, whereas also describes design methodologies developing evaluating them. A systematic bibliographic search identified 19 differing considerably (rule-based systems, documentary approach, mixed); outputs (textual report, alerts and/or visual approaches); evaluations (impact clinical practices, impact patient outcomes, efficiency user satisfaction). The performed minimal (among all identified, only one system has evaluated according criteria mentioned above) no machine learning conflict management were retrieved. This highlights need develop new methodologies, combining various approaches decision support

Язык: Английский

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Drug–Drug Interactions and Actual Harm to Hospitalized Patients: A Multicentre Study Examining the Prevalence Pre- and Post-Electronic Medication System Implementation

Drug Safety, Год журнала: 2024, Номер 47(6), С. 557 - 569

Опубликована: Март 13, 2024

Drug–drug interactions (DDIs) have potential to cause patient harm, including lowering therapeutic efficacy. This study aimed (i) determine the prevalence of DDIs (pDDIs); clinically relevant (cDDIs), that is, could lead taking into account a patient's individual clinical profile, drug effects and severity harmful outcome; subsequent actual harm among hospitalized patients (ii) examine impact transitioning from paper-based medication charts electronic management (eMM) on harms. was secondary analysis control arm controlled pre-post study. Patients were randomly selected three Australian hospitals. Retrospective chart review conducted before after implementation an eMM system, without accompanying decision support alerts for DDIs. Harm assessed by expert panel. Of 1186 admissions, 70.1% (n = 831) experienced pDDI, 42.6% 505) cDDI 0.9% 11) in hospital. 15,860 pDDIs identified, 27.0% 4285) classified as cDDIs. The median number cDDIs per 10 drugs 6 [interquartile range (IQR) 2–13] 0 (IQR 0–2), respectively. In cases where both 44% less likely be co-administered following (adjusted odds ratio 0.56, 95% confidence interval 0.46–0.73). Although most pDDI during their hospital stay, than one-third relevant. low identified raises questions about value incorporating DDI systems given negative impacts alerts.

Язык: Английский

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Exploring geriatric syndromes among physically disabled older adults: A network analysis

Geriatric Nursing, Год журнала: 2025, Номер 62, С. 54 - 61

Опубликована: Янв. 25, 2025

Язык: Английский

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