Bmc Med
-
Randomized Controlled Trial
Impact of medication nonadherence and drug-drug interaction testing on the management of primary care patients with polypharmacy: a randomized controlled trial.
Clinical management of patients with chronic cardiometabolic disease is complicated by polypharmacy. Consequently, when patients clinically deteriorate, physicians are challenged to distinguish both medication nonadherence and drug-drug interactions (DDI) from chronic disease progression. ⋯ Although intervention and control PCPs similarly detected and acted upon medication nonadherence and DDI at baseline, intervention PCPs' detection increased significantly after using the CDMT. Also, the clinical actions performed with CDMT support were more clinically rigorous. These outcomes support the clinical utility of CDMT in the management of symptomatic patients with cardiometabolic disease and polypharmacy.
-
Front-of-pack (FOP) warning labels have demonstrated effectiveness for reducing sugar-sweetened beverage (SSB) consumption and switching to water. However, an unintended consequence is that they may also increase switching to non-sugar-sweetened beverages (NSSBs). A non-hypothetical experimental study examined the effectiveness of combining sugar and sweetener FOP warning labels to reduce sugary drink consumption and prevent NSSB substitution. The study also examined potential integration with Australia and New Zealand's existing Health Star Rating (HSR) system to determine suitability for local context and other jurisdictions with interpretive labelling schemes already in place. ⋯ Results demonstrate the potential of FOP sugar warning labels for addressing beverage consumption behaviours. The incorporation of sweetener warning labels may successfully avoid substitution towards NSSBs, whilst still promoting water choices, but may also dilute the impact of the sugary drinks warning labels. Warning labels were complementary to existing interpretive FOP labels.
-
In the contemporary management of heart failure with reduced ejection fraction (HFrEF), the recommended quadruple guideline-directed medical therapy (GDMT) consists of angiotensin receptor-neprilysin inhibitor (ARNI), evidence-based beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter-2 inhibitors (SGLT-2i). This study explored the impact of adding implantable cardioverter-defibrillator (ICD) therapy to this comprehensive regimen in HFrEF patients. ⋯ This study may offer a glimmer of hope that even after achieving the best current optimal medical therapy, the addition of device therapy could still yield positive outcomes in the management of patients with HFrEF.
-
Bipolar disorder is a complex polygenic disorder that is characterized by recurrent episodes of depression and mania, the heterogeneity of which is likely complicated by epigenetic modifications that remain to be elucidated. ⋯ The epigenetic and pathophysiological mechanism linking AP1AR-DT to the modulation of depressive and anxiety-like behaviors and excitatory synaptic function provides etiological implications for bipolar disorder.
-
Multicenter Study
Triglyceride-lowering therapies in hypertriglyceridemia-associated acute pancreatitis in China: a multicentre prospective cohort study.
No specific triglyceride-lowering therapy is recommended in patients with hypertriglyceridemia-associated acute pancreatitis (HTG-AP), primarily because of the lack of quality evidence. This study aimed to describe practice variations in triglyceride-lowering therapies for early HTG-AP patients and assess whether more rapid triglyceride decline is associated with improving organ failure. ⋯ Triglyceride-lowering therapies vary greatly across centres. More rapid triglyceride decline was not associated with improving incidence and duration of organ failure.