Search Results (106)

Objectives: Scarce data are available regarding preventive medicine in forcibly displaced populations especially regarding non-communicable diseases like neoplasia, while even more limited data are available on Ukrainian refugees in Romania. To address this research gap, the present analysis was performed to investigate Ukrainian refugee women’s beliefs, attitudes, and opinions towards the Romanian and Ukrainian healthcare system in a comparison model while focusing on the HPV immunization rates and factors influencing the uptake for themselves and their children. Methods: Participants were recruited using the snowball sampling method through their General Practitioner (GP) and a health mediator. Results: In total, 105 women completed the online or physical survey. The mean age was 50 years. In total, 40% of women had not been to a gynecological check-up in 3 or more years, and more than 56% had never been screened. Only four were vaccinated against HPV, and none remembered which type of vaccine was dispensed or how many doses were utilized. The primary hindrances to accessing health services or immunization programs were language barriers, financial burdens, and a lack of information. Respondents’ general distrust of health systems and healthcare workforces were recurrent themes. Relationship status, living arrangements, and previous engagement in screening practices influenced immunization rates. Perceiving the healthcare officials as proactive concerning optional vaccination programs such as HPV immunization and actively receiving recommendations drove respondents to pursue vaccination. Conclusions: This analysis offers a foundational insight into the specific needs of refugee women. It can guide the development of effective public health interventions to improve health outcomes and vaccination rates among Ukrainian refugees in Romania. Tailored preventive campaigns with adequate native language information and prompts from medical experts in designated centers should be deployed to ensure inclusive tactics for vulnerable populations. Full article

Gas bubbles are one of the main disturbances encountered when dispensing drugs of microliter volumes using portable miniaturized systems based on piezoelectric diaphragm micropumps. The presence of a gas bubble in the pump chamber leads to the inaccurate administration of the required dose due to its impact on the flowrate. This is particularly important for highly concentrated drugs such as insulin. Different types of sensors are used to detect gas bubbles: inline on the fluidic channels or inside the pump chamber itself. These solutions increase the complexity, size, and cost of the microdosing system. To address these problems, a radically new approach is taken by utilizing the sensing capability of the piezoelectric diaphragm during micropump actuation. This work demonstrates the workflow to build a self-sensing micropump based on artificial intelligence methods on an embedded system. This is completed by the implementation of an electronic circuit that amplifies and samples the loading current of the piezoelectric ceramic with a microcontroller STM32G491RE. Training datasets of 11 micropumps are generated at an automated testbench for gas bubble injections. The training and hyper-parameter optimization of artificial intelligence algorithms from the TensorFlow and scikit-learn libraries are conducted using a grid search approach. The classification accuracy is determined by a cross-training routine, and model deployment on STM32G491RE is conducted utilizing the STM32Cube.AI framework. The finally deployed model on the embedded system has a memory footprint of 15.23 kB, a runtime of 182 µs, and detects gas bubbles with an accuracy of 99.41%. Full article

Background and Objectives: Medication errors are a critical issue in healthcare systems worldwide, contributing to significant patient harm, with studies indicating that medication-related incidents are among the most common causes of adverse events in medical practice. There are between 80 and 200 steps in providing a single patient with a single dose of drugs, with five stages, including prescription, preparation, dispensation, administration and monitoring. This study aims to describe and validate the MAEs (Medication Administration Error Scale) tool, which investigates the most common causes of medication errors in medication administration. Materials and Methods: Independent translators translated the original version of the scale using language verification. The agreed-upon version of the translation was then assessed by a team of nurses, specialists in anaesthetic and intensive care nursing, in terms of understanding the translated content. After introducing changes resulting from linguistic and organisational differences, a survey questionnaire was prepared and used in the pilot study. Eighty-six respondents participated in the pilot study via the Office 365 platform and the Forms programme. The research was led by nurses who work in highly specialised units. The reliability of the translated version of the questionnaire was examined by calculating the Cronbach’s alpha coefficient. Results: The tool’s internal consistency across ranges was within acceptable limits. For part A (questions 1–29), it was 0.93; for part B (questions 30–45), it was 0.94. In part C, regarding the percentages of the type of error occurring in a given medical facility, Cronbach’s alpha coefficient was 0.97. When the factor loadings of the items were evaluated, they were determined to be in the range of 0.602–0.783. In this context, the factor loading levels of the items in the 5-factor model were high and sufficient. Conclusions: The statistical analyses suggest that the Polish version of the Medication Administration Error Survey demonstrates satisfactory reliability and is a promising tool for assessing the cause of medication administration errors. Full article

The COVID-19 lockdown had significant consequences on the mental health of millions of people, leading to the increasing prescription and use of psychotropic drugs. Due to the lack of data in the current literature, this study aims to estimate the trends in the consumption of anxiolytics, antipsychotics, and antidepressants before and during the pandemic on people in the South Italian region. We conducted a retrospective observational study, retrieving prescriptions of anxiolytics, antipsychotics, and antidepressants dispensed in pharmacies of the Basilicata region (South Italy) for the period 2019–2021. We presented the data, expressed in Daily Defined Doses (DDDs) for 1000 persons/day (DHD), on a total resident population of 95,021, dividing the age groups into categories <30, 30–50, 50–70, and >70 years. We conducted a linear regression model to examinate consumption trends across years. Software XLSTAT was used for statistical analysis. During the study period, more than 85,000 boxes of psychotropic medications were dispensed. The research showed an increase in the sales of all three categories of drugs examined, with a greater rise in benzodiazepines (88.5%) and selective serotonin reuptake inhibitors (81.9%) in 2021 compared to 2019, especially among women under 30 years. The COVID-19 pandemic had led to an increase in the consumption of psychotropic drugs, confirming the significant impact on the population’s mental health. Full article

Introduction: The COVID-19 pandemic has disrupted antibiotic use; easing public health measures may alter infection presentations and antibiotic prescribing in primary care. The study investigated post-pandemic antibiotic utilisation trends in primary care. Methods: A multi-centre, retrospective cohort study was conducted across seven public primary care clinics in Western Singapore, which included all patients prescribed oral antibiotics between 2022 and 2023. Descriptive statistics were used to visualise the prevalence and conditions of the prescribed antibiotics. Antibiotic quality was evaluated using the WHO’s AWaRe (access, watch, reserve) classification. Antibiotic use was quantified using the number of items dispensed per 1000 inhabitants (NTI), defined daily doses (DDD) per 1000 inhabitants per day (DID), and DDD per 100 visits. Segmented regression analysis was applied to monthly prescriptions to assess the utilisation trends. Results: Antibiotic prescription rates increased significantly, from 3.5% in 2022 to 4.0% in 2023 (p = 0.001), with a 9.5% relative increase (38,920 prescriptions for 1,112,574 visits to 42,613 prescriptions for 1,063,646 visits). Respiratory conditions drove the increase in antibiotics use, with a 68.3% rise in prescriptions, with upper respiratory tract infections being the most common diagnosis for antibiotic prescriptions (n = 9296 prescriptions in 2023), with a steady monthly upward trend. Access group antibiotics accounted for >90% of prescriptions. The most antibiotics were prescribed for acne, with 36,304 DDD per 100 visits in 2023. Both NTI and DID significantly increased in 2022, largely contributed by a >100% increase in Watch group antibiotic use. Total antibiotic NTI dipped slightly in 2023, with a stable trend in both NTI and DID for all antibiotics. Conclusions: The post-COVID-19 pandemic surge in the antibiotic prescription rate for respiratory conditions and Watch group antibiotic use highlight the need for targeted stewardship interventions. Optimising acne treatment and diagnosis coding are key strategies to further reduce unnecessary prescriptions. Full article

Background: Type 2 diabetes is a chronic disease with high global prevalence and significant social and economic burden. The pandemic affected patients’ diagnostics and medicines dispensing. Diabetes was among the most-affected conditions during lockdown due to the limited resources and unaffordable medicines. The impact of the pandemic on utilisation and cost has not been thoroughly studied, which inspired us to conduct the current study. Objectives: The study explored cost dynamics, changes in antidiabetic medicines utilisation, and public expenditure of pharmacotherapy in three periods: pre-pandemic (2018–2019), during the pandemic (2020–2021), and post-pandemic (2022–2023). Methods: It is a retrospective, observational, macroeconomic analysis. Reimbursed cost and utilisation were analysed as a crude sum and as indexes of the average value. Results: The result shows that five new INNs have been included in the Positive Medicines List (PML), two of these being fixed dose combinations (FDCs). During the pandemic, a slow tendency of increase of the crude sum of public expenditure was observed, followed by a sharp increase in the post-pandemic period. The public spending increased more than twice, and we found a 30,018,982 Euro growth. The highest public spending is found for dapagliflozine in post-pandemic vs. pandemic period (index = 1.67), as well as empagliflozin/metformin and dapagliflozine in pandemic vs. pre-pandemic period (index = 0.21). Total utilisation increases from 58.16 to 71.78 DDD/1000 inh/day during 2018–2023. The most significant rise of utilisation is found for canagliflozin (index = 0.68) pandemic vs. pre-pandemic and dapagliflozin (index = 3.66) post-pandemic vs. pandemic. Conclusions: Analysis of the antidiabetic medicines market reveals the rising of reimbursed cost and utilisation in pre-, post-, and during the pandemic. In conclusion, organisation of the supply and financing of antidiabetic medicines was not affected during the pandemic. Full article

Water-based nutrient injection technology, widely used in sectors like viticulture, hydroponics, and intensive animal systems, has previously seen limited application in livestock production. Early mechanical dispensers for nutrients, such as non-protein nitrogen (NPN) and phosphorus (P), were prone to malfunction, leading to inconsistent dosing and potential livestock health risks. This contributed to skepticism and slow adoption among producers. However, recent technological advancements have renewed interest in water-based supplementation for grazing animals. This case study assessed the use of water injection technology to deliver nutrients and a methane-reducing compound to cattle on a commercial cattle station under extensive grazing conditions. A total of 120 steers [initial liveweight (LW) 322.5 ± 28.3 kg] were assigned to three groups: water only (Control), a water supplement containing nutrients such as nitrogen and phosphorus, known as uPRO GREEN^® (Green), and uPRO GREEN^® combined with Agolin Ruminant L^® (Blue). The experiment lasted 90 days, during which LW was continuously monitored via a walk-over weighing system, and water disappearance was measured at the mob level. Methane emissions were forecasted using dry matter intake estimates based on observed animal growth rates. Additionally, 24 steers were equipped with on-animal sensors with GPS to monitor behavioral changes. The results indicate that despite the potential reduction in water intake (Control and Green: 948.1 and 973.5 L/d, respectively, versus 547.5 L/d for Blue), there were no negative effects on growth (mean average daily gain of 1.32 kg/d) or animal behaviors. The predicted methane emission of 209.04 g CH₄/head/day could potentially be reduced by 10–15% with the compound used in the current trial. These findings suggest that water-based supplementation can be used to optimize nutrient delivery and a methane-reducing compound without compromising cattle productivity in extensive grazing environments. In addition, the potential enteric methane mitigation presents an opportunity for livestock producers to generate additional revenue through carbon credits or to create new markets for beef with low greenhouse gas emissions when cattle consume methane-reducing compounds. Full article

Background/Objectives: An automated extrusion-based material deposition is a contemporary and rapid method for pharmaceutical dose-dispensing and preparing (printing) individualized solid dosage forms. The aim of this study was to investigate and gain knowledge of the feasibility of automated extrusion-based material deposition technology in preparing customized prednisolone (PRD)-loaded gel tablets for veterinary applications (primarily for dogs and cats). Methods: The PRD loads of the extrusion-based deposited gel tablets were 0.5% and 1.0%, and the target weights of tablets were 0.250 g, 0.500 g, and 1.000 g. The effects of the material deposition processes on the physical solid state, in vitro dissolution, and the physicochemical stability of PRD gel tablets were investigated. Results: The small-sized gel tablets presented a uniform round shape with an exceptionally smooth outer surface texture. The actual average weight of the tablets (n = 10) was very close to the target weight, showing the precision of the process. We found that PRD was in a pseudopolymorphic sesquihydrate form (instead of an initial PRD crystalline form II) in the gel tablets. In all the immediate-release gel tablets studied, more than 70% of the drug load was released within 30 min. The soft texture and dimensions of gel tablets affected the dissolution behaviour in vitro, suggesting the need for further development and standardization of a dissolution test method for such gel tablets. A short-term storage stability study revealed that the content of PRD did not decrease within 3 months. Conclusions: Automated extrusion-based material deposition is a feasible method for the rapid preparation of gel tablets intended for veterinary applications. In addition, the present technology and gel tablets could be used in pediatric and personalized medicine where precise dosing is crucial. Full article

Background: Mycophenolate mofetil is used for the prevention of solid organ transplant rejection and for other indications, such as systemic lupus erythematosus (SLE). Objective: To determine the prescription patterns of mycophenolate mofetil in a group of Colombian patients. Methods: This was a cross-sectional study of patients receiving mycophenolate mofetil between 2021 and 2022. The data were obtained from a drug dispensing database. Sociodemographic, clinical (diagnostic), and pharmacological variables were identified. Results: A total of 979 patients who underwent treatment were identified; their mean age was 45.9 ± 17.1 years, and 87.4% were women. The main diagnosis associated with the use of mycophenolate mofetil was SLE (39.1%), followed by other rheumatic diseases (8.5%), nephrotic syndrome (7.5%), and solid organ transplantation (6.4%). The relationship between the mean dose and the defined daily dose was 0.75. Ten percent of patients received mycophenolate alone, whereas 32.9% received mycophenolate in combination therapy with conventional disease-modifying antirheumatic drugs and glucocorticoids. A total of 76.2% had polypharmacy (five or more drugs). Conclusions: Mycophenolate mofetil is used mainly in combination therapy for patients with SLE and other rheumatological diseases and for solid organ transplants at doses lower than those recommended. Full article

A novel means of applying radiotherapy in cancer treatment is the application of a radiation dose at a very high intensity for a very short time in FLASH radiotherapy (FLASH-RT). This technique involves the exposure of tumors to >40 Gy/s, usually for less than one second. Studies conducted in cell and preclinical models suggest that FLASH-RT seems less damaging to normal tissues from adverse effects relative to the same overall dose of radiation administered in conventional therapy (CONV-RT), which involves the administration of lower levels of radiation repeated intermittently over a protracted period. In contrast, the susceptibility of tumor tissues to FLASH-RT is not diminished relative to CONV-RT. Within solid tumors, both modes of dispensation of radiation produce an equivalent degree of cell damage. The differential treatment between normal and malignant material has been found in isolated tissues, animal studies and, more recently, in clinical trials. However, the classic radiation concept is that high-energy linear transfer radiation (LET) is more damaging than the equivalent total dose of low LET. Thus, the susceptibility of cells should be greater after short-term exposure to high LET. This article discusses the potential reasons that may account for this discrepancy. While the relative protection given to untransformed tissues by FLASH-RT relative to tumor tissue is a major step forward in radiation therapy for cancer, the processes that lie behind this phenomenon are incompletely understood and are considered here. Full article

Digital weight-loss services (DWLSs) combining pharmacotherapy and health coaching have the potential to make a major contribution to the global struggle against obesity. However, the degree to which DWLSs compromise patient safety through the dispensation of Glucagon-like peptide-1 receptor agonist (GLP-1 RA) medications is unknown. This study retrospectively analysed the rate at which patients reported GLP-1 RA dispensing errors from patient-selected and partner pharmacies of Australia’s largest DWLS provider over a six-month period. The analysis found that 99 (0.35%) of the 28,165 dispensed semaglutide orders contained an error. Incorrect dose (58.6%) and unreasonable medication expiry window (21.2%) were the two most common error types. Most errors (84.9%) were deemed to have been of medium urgency, with 11.1% being considered high-urgency errors. Incorrect doses (45.5%) and supplies of the wrong medication (36.3%) comprised most errors reported in high-urgency cases. Female patients reported more dispensing errors than male patients (0.41% vs. 0.12%, p < 0.001). Similarly, reported dispensing error rates were highest among patients aged 18 to 29 years (0.6%) and 30 to 39 years (0.5%). This research provides preliminary evidence that GLP-1 RA dispensing errors within comprehensive Australian DWLSs are relatively low. Full article

Background: Previous studies found that the coronavirus disease 2019 (COVID-19) pandemic had a variable impact on the consumption of antimicrobial drugs in human medicine, with trends in several European countries differing between community and inpatient prescribing. Aim: This study analysed changes in the volumes and use density of antibacterial and antifungal drugs dispensed in acute care hospitals in Germany between 2019 and 2022. Methods: Surveillance data for the four years available from 279 hospitals were expressed as the total volumes of daily doses or as use density (daily doses per 100 patient/occupied bed days) per year and analysed descriptively, using recommended hospital-adapted daily dose definitions (RDDs) and (as sensitivity analysis) WHO/ATC-defined daily dose definitions (DDD). Hospitals were stratified according to size (number of beds), university affiliation, and location (East, West, South). Results: There were significant decreases in both the total number of patient days and antibacterial drug volumes in 2020 through 2022 compared with 2019. The relative changes between 2019 and 2020, 2021, and 2022 were −12.8%, −13.5%, and −13.3% for patient days, and −9.7%, −11.0%, and −10.1% for antibacterial RDDs, respectively. Broad-spectrum betalactams, notably piperacillin–tazobactam and carbapenems, increased in volume, unlike most other drug classes. The resulting antibacterial drug use density was slightly but significantly increased, with pooled means (and medians) of 43.3 (40.0) RDD/100 in 2019 compared to 44.8 (41.7), 44.5 (40.80), and 44.9 (41.7) RDD/100 in the years 2020 through 2022, respectively. Antifungal drug volumes and use density increased after 2019 and peaked in 2021 (the difference between 2019 and 2021 for total volumes was +6.4%, and that for pooled mean use density values was +22.9%, respectively). These trends were similar in the different hospital strata and comparable when DDDs instead of RDDs were used. Conclusions: Similar to what has been observed in a majority of European countries, the total volume of antibacterial drug use in German acute care hospitals decreased with the pandemic, without a rebound phenomenon in 2022. In association with restricted hospital capacities and presumably more immunocompromised general medicine patients, however, inpatient prescribing of (primarily broad-spectrum) antibacterials and of antifungal drugs increased. Full article

In most countries, antibiotics for oral administration are put on the market in fixed packages. When there is no exact unit dispensing of antimicrobials, drug pack size may influence prescribers’ choice of treatment duration. The aim of this study was to investigate the accordance of approved antibiotic packages with national guidelines for the treatment of community-acquired pneumonia (CAP). For the purpose of this study, criteria were developed to determine the accordance of approved antibiotic packages for treating CAP (criteria), which are based on recommendations from national guidelines for treating CAP. Subsequently, the accordance of approved antibiotic packages with the number of antibiotic doses resulting from the specified criteria was determined. Of 39 identified therapeutic option-package size combinations, 11 were found to be matched (28.2%), meaning there were no leftover medication units after completing therapy, and 28 were mismatched combinations (71.8%), indicating that there were excess doses of antibiotics remaining at the end of therapy. The results of this research showed a significant non-accordance of the approved antibiotic packages with the national guidelines for the treatment of CAP and, consequently, the creation of a large amount of residues of unit doses of antibiotics in the community. Full article

Centrifugal disk dispensers are widely used in various tasks of dosing bulk, dispersed materials. The design of the disk depends on the physical and mechanical characteristics of the dosing medium. The work discusses the development of an analytical model of the movement of a material particle along a conical centrifugal disk depending on the kinematic characteristics of the dosing process and the characteristics of the dosing material, as well as experimental confirmation of the theoretical model, which is relevant for the calculation and design of working elements of this type. The obtained system of differential equations is solved using the Runge–Kutta numerical method. Experimental studies were carried out using the method of a planned factorial experiment. The experiment was conducted for three factors at three levels. The feedback criterion was the performance of a centrifugal conical disk dispenser for bulk materials. The disk cone angle was set at 10, 20, and 30°. The disk diameter was 130, 150, and 170 mm, the gap between the disk and the edge of the hopper neck was 6, 8, and 10 mm, and the rotational speed of the conical disk was 0.65, 1.02, and 1.39 rad/s. The dispensing rate of the dispenser ranged from 15 to 770 g/s, depending on the values of the experimental factors. For use in the regression equation of the natural values of the factors, a method of transforming the terms of the equation from coded values to natural ones is provided. The obtained experimental correlation dependencies were checked for reproducibility with Cochrane’s test, and the adequacy of the model was checked using Fisher’s test. The significance of the coefficients in the correlation equation was evaluated using the Student’s t-test. The difference between the experimental data and the results of the theoretical modeling does not exceed 5%. The obtained system of differential equations makes it possible to model the radial velocity of the ascent of bulk material from the conical rotating disk depending on the rotation frequency, disk diameter, and the height of the annular gap between the discharge throat of the hopper and the conical disk. The analytical model enables the modeling of the productivity of the conical dispenser for bulk materials for arbitrary parameters of rotation frequency, disk diameter, and the size of the annular gap between the discharge throat of the hopper and the conical disk. Full article

Increasing insomnia signals a public health problem, alongside rising zolpidem use. This study investigates the factors behind the disproportionate rise in zolpidem prescriptions in Taiwan. It aims to identify the determinants of high-dose zolpidem users in Taiwan’s Yilan County and employ an innovative approach to outline their medication-seeking patterns, using Taiwan’s healthcare database. The associations between sociodemographic and clinical factors and low-dose and high-dose users were analyzed using multiple logistic regression. Social network analysis was employed to explore medication-seeking behavior among these user groups across different healthcare institutions. Of our 5290 participants, 22.82% are high-dose users. This study found that males face a 1.33-fold higher risk and that having chronic diseases is a major risk factor, contributing to a more than four-times higher risk (adjusted OR = 4.27, 95% CI 1.55–11.70) of being a high-dose user of zolpidem. A social network analysis showed a higher density (0.52) for high-dose users, revealing their frequent visits, for zolpidem, to different healthcare institutions. Psychiatrists have a central role in both low-dose and high-dose user networks, with a greater influence on low-dose users (64.4) than high-dose users (32.2). In sum, patients seeking high doses of zolpidem are driven by personal factors. Future efforts should include regulated dispensing, public health education, and specialized training for healthcare professionals on drug addiction. Full article