Search Results (421)

Background/Objectives: Adults with intellectual disability (ID) experience high rates of psychiatric comorbidity but often face diagnostic challenges and treatment barriers, leading to inappropriate psychotropic medication use. This study examined the extent to which specialized psychiatric assessment and improved diagnostic accuracy had an impact on medication management and clinical outcomes in adults with ID and co-occurring psychiatric disorders. Methods: This observational retrospective study analyzed medical records from 25 adults with ID who underwent specialized psychiatric assessment at a community-based service in Italy between January 2023 and January 2024. Psychopathological diagnoses were established according to Diagnostic Manual—Intellectual Disability, Second Edition (DM-ID2) criteria, based on clinical observation and a comprehensive assessment using validated instruments. Clinical outcomes were assessed using a psychometric tool encompassing multiple psychopathological and behavioral dimensions. Data on psychotropic prescriptions and side effects were also collected. Non-parametric analyses were performed, with significance set at α = 0.05. Results: The proportion of patients with a psychiatric diagnosis increased from 32% to 96% after specialized assessment (p < 0.001), with notable rises in depressive (0% to 32%), bipolar (8% to 36%), anxiety (4% to 24%), and impulse control (0% to 16%) disorders. First-generation antipsychotic prescriptions decreased (from 36% to 8%, p = 0.023), while antidepressant use increased (from 12% to 52%, p = 0.004). The mean number of side effects per patient declined from 1.6 to 0.5 (p < 0.001), particularly the elevated prolactin level and psychomotor retardation. Significant improvements were observed in symptom intensity and frequency across multiple domains, including aggression, mood disturbances, and compulsions (p < 0.001). Conclusions: In this single-center retrospective study, specialized psychiatric assessment was associated with improved diagnostic accuracy, medication management, and clinical outcomes in adults with ID. The increase in psychiatric diagnoses likely reflects improved identification, addressing key challenges in precision diagnosis for people with neurodevelopmental disorders. Although the overall number of prescribed medications remained stable, optimization of treatment regimens reduced first-generation antipsychotic use and related adverse effects. These findings indicates that access to specialized assessment and precision diagnosis could improve psychopharmacological interventions and outcomes for this vulnerable population, but larger, multi-center and longer-term studies are needed to confirm these results. Full article

People with intellectual disabilities frequently use psychotropic and other medications, sometimes inappropriately. To promote shared decision-making, they require accessible information about their medication. This study combined data from two similar intervention studies, conducted in two different settings, to assess the appropriateness of medication use and the shared decision-making process among adults with mild intellectual disabilities who used psychotropic medication. The intervention consisted of a structured, multidisciplinary medication review, including the provision of accessible psychotropic medication leaflets, and a discussion of the pharmacotherapeutic treatment plan with the patient by either a pharmacist or physician, depending on the setting. Outcomes included medication use, pharmacotherapeutic problems, implementation of recommendations, and perceived shared decision-making, measured with the Shared Decision-Making Questionnaire Q9. The 15 included participants used an average of nearly seven medications, which were mainly neurotropic, gastrointestinal, cardiovascular, and respiratory agents. On average, two pharmacotherapeutic problems were identified; the most common were overtreatment, side effects, and administration difficulties. Recommendations often involved dose reduction or tapering, and about 75% were fully or partially implemented. Both participants and clinicians reported high satisfaction with shared decision-making. Multidisciplinary, structured medication reviews, incorporating accessible medication leaflets, may enhance appropriate medication use and shared decision-making, but more research is needed. Full article

Inappropriate use of antibiotics can stimulate antimicrobial resistance, since bacteria are capable of circumventing pharmacological action through various resistance mechanisms. Recently, during the COVID-19 pandemic, there has been an increase in the use of antimicrobials. This is an analytical, quantitative, and retrospective study on bacterial resistance and mortality in Intensive Care Unit (ICU) patients from 2017 to 2022. This study analyzed sociodemographic aspects, clinical, and laboratory parameters in patients admitted to the ICU. A total of 221 medical records of patients with multidrug-resistant bacteria in the ICU were included, with an outcome of 95 discharges (42.98%) and 126 deaths (53.01%). An increase in the prevalence of bacterial resistance in the ICU was identified during the Pandemic period, when compared to the Pre-Pandemic period. It was identified that the increase in bacterial resistance of some pathogens was associated with death. It was also observed that age was a factor for an increased risk of mortality in the ICU, no matter the sex of the patient. Importance of careful analysis in the use of antimicrobials, as well as in the care of ICU patients and in the surveillance of bacterial infections by health professionals. Full article

Sudden cardiac death (SCD) remains a major clinical challenge, with implantable cardioverter-defibrillators (ICDs) serving as the primary preventive intervention. Current patient selection guidelines rely on limited and imperfect risk markers. This study explores the potential of machine learning (ML) models to improve SCD risk prediction using tabular clinical data that include features derived from medical sensing devices such as electrocardiograms (ECGs) and ICDs. Several ML models, including tree-based models, Naive Bayes (NB), logistic regression (LR), and voting classifiers (VC), were trained on demographic, clinical, laboratory, and device-derived variables from patients who underwent ICD implantation at a Croatian tertiary center. The target variable was the activation of the ICD device (appropriate or inappropriate/missed), serving as a surrogate for high-risk SCD detection. Models were optimized for the F2-score to prioritize high-risk patient detection, and interpretability was achieved with post hoc SHAP value analysis, which confirmed known and revealed additional potential SCD predictors. The random forest (RF) model achieved the highest F2-score (F2-score 0.74, AUC-ROC 0.73), demonstrating a recall of 97.30% and meeting the primary objective of high true positive detection, while the VC classifier achieved the highest overall discrimination (F2-score 0.71, AUC-ROC 0.76). The predictive performance of multiple ML models, particularly the high recall they achieved, demonstrates the promising potential of ML to refine ICD patient selection. Full article

Malaria remains a critical global health challenge for doctors and healthcare practitioners, particularly clinicians involved in initial treatment. Inaccurate diagnosis of malaria-infected cells often leads to delayed or inappropriate treatment, increasing the risk of severe complications or death. Traditional microscopic diagnosis is time-consuming and requires expert skills, resulting in variability and inconsistency in results. These challenges are further complicated by the complexity of malaria symptoms, which overlap with other febrile illnesses, making clinical diagnosis unreliable without laboratory confirmation. To address these challenges, this study explores deep-learning-based approaches, particularly leveraging state-of-the-art pretrained convolutional neural network (CNN) models, for automated malaria parasite detection and classification from microscopic blood smear images. Transfer learning is an effective approach to handling issues such as limited labeled data, time-consuming training, and domain-specific variations in medical image classification. By leveraging pretrained models trained on large-scale datasets like ImageNet, transfer learning enables the reuse of learned features, significantly accelerating the adaptation process for malaria detection and other medical imaging tasks. We used eight pretrained models for malaria parasite classification such as VGG16, VGG19, Inception-v3, ResNet-18, ResNet-34, ResNet-50, ResNet-101, and Xception. In particular, ResNet-50 and ResNet-101 achieved accuracies of approximately 89%, respectively, while Xception reached around 88% accuracy. In comparison, VGG-16 achieved a lower overall accuracy of about 80% due to a recall trade-off despite high precision. These metrics highlight meaningful improvements over simpler architectures and validate the efficacy of our transfer learning approach for automated malaria detection. The proposed models were fine-tuned on extensive labeled datasets comprising parasitized and uninfected cells. Quantitative and qualitative evaluations were conducted using metrics such as precision, recall, F1-score, and support. Our experimental results demonstrate that ResNet-50, ResNet-101, and Xception exhibit strong balanced performance with higher accuracy, while VGG-16 shows a trade-off of high precision but lower recall for parasitized cells. Full article

The increasing use of multiple medications among older adults raises concerns about potentially inappropriate medications (PIMs), which are associated with adverse health outcomes and increased healthcare costs. This study aimed to assess the prevalence and types of PIMs dispensed to older adults living in Northwest Italy using real-world pharmacy claims data. An observational, retrospective analysis was conducted on anonymized drug dispensing datasets from two local health authorities, covering individuals aged 65 years or older between 2018 and 2021. PIMs were identified according to the 2019 American Geriatrics Society Beers Criteria, focusing on drugs that are inappropriate or should be used with caution in older adults or have anticholinergic properties. Over half of older adults who received medications during the study period were dispensed at least one PIM, with stable or slight increased prevalence over time with no differences by sex or region. Proton-pump inhibitors used for more than 8 weeks and paroxetine were the most common PIMs, while furosemide and sulfonylureas were also frequently reported PIMs. These findings indicate a persistently high burden of inappropriate prescribing in older adults and highlight the need for coordinated deprescribing interventions and prescriber education to promote safer, evidence-based pharmacotherapy in aging populations. Full article

Background: Self-medication with leftover antibiotics (SMLA) drives antimicrobial resistance (AMR), particularly in developing countries. This study examined knowledge–practice gaps regarding antibiotic use and handling among individuals with prior SMLA across seven developing countries. Methods: A cross-sectional study (February 2023–February 2024) included 3191 adults from Bangladesh, Brazil, Egypt, India, Jordan, Lebanon, and Serbia who reported previous leftover antibiotic use. The questionnaires assessed knowledge of antibiotic use (15 items), resistance (12 items), and SMLA risks (15 items). Storage and disposal practices were evaluated using dichotomized correct/incorrect measures. Results: Participants demonstrated above-average knowledge scores as follows: antibiotic use (54.4 ± 8.4), resistance (43.3 ± 6.1), and SMLA risks (58.4 ± 10.3). However, substantial practice gaps emerged. Only 21.9% properly disposed of leftover antibiotics, while 47.0% used household garbage. For storage, 55.1% used appropriate methods, but 32.6% stored antibiotics inappropriately, and 12.8% lacked protocols. Serbian participants showed the highest SMLA risk knowledge (64.3 ± 10.6), Bangladeshi participants the lowest (52.0 ± 8.5, p < 0.001). Women had superior knowledge (59.6 ± 10.4 versus 56.5 ± 9.8, p < 0.001) and storage practices (56.6% versus 52.7%, p = 0.031). Paradoxically, higher AMR knowledge was associated with poorer disposal practices (OR = 0.97, p < 0.001). Conclusions: Despite extensive theoretical knowledge, unsafe medication practices persist, revealing a critical knowledge–practice gap. Our findings challenge education-focused AMR approaches, suggesting cognitive awareness alone cannot drive behavioral change. Effective interventions must address structural barriers, cultural factors, and individual health beliefs beyond traditional knowledge-deficit models. Full article

Background/Objectives: Prevention and treatment of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major clinical issue in hospitalized patients. Some aspects of VTE management lack clarity due to differing physicians’ opinions and behaviors. Methods: A multidisciplinary steering committee identified two main areas of uncertainty: VTE prophylaxis and PE management in special settings. A multiple-choice questionnaire including 10 statements was circulated to 183 doctors trained in VTE management. The expected benefit-to-harm ratio was represented on a nine-point Likert scale, with consensus (≥75% agreement) on scores of 1–3 indicating inappropriate and 7–9 indicating appropriate care measures. Results: In online voting, a consensus was reached for 9/10 statements. Respondents considered the following to be appropriate: risk assessment of VTE (93.44%) and bleeding (91.6%) in hospitalized medical patients; low-molecular weight heparin (LMWH) prophylaxis for inpatients with pneumonia and malignancy (82.78%); therapeutic doses of LMWH/fondaparinux in patients with intermediate/high risk of PE with (80.9%) or without (77.97%) instability criteria; and echocardiography to manage patients with a post-PE syndrome (93.99%). Respondents considered the following to be inappropriate: use of 4000 IU LMWH in chronic renal failure (80.46%); use of 2000 IU LMWH in persons on dual antiplatelet therapy (77.01%); and use of low-dose apixaban (2.5 mg) in pregnancy (88.57%) or in subsegmental PE with hypoxemia (82.46%). No consensus was reached on the identification of PE cases eligible for outpatient treatment. Conclusions: Our findings show persistent gaps between guideline recommendations and clinical implementation despite improved awareness among physicians. Uncertainty persists regarding criteria for outpatient PE eligibility and/or for validation of bleeding-risk models. Full article

Polypharmacy and the use of potentially inappropriate medications (PIM) are prevalent issues among institutionalized older adults, contributing to adverse drug events and decreased quality of life. This study aimed to describe the sociodemographic and clinical characteristics associated with polypharmacy and the use of PIM in elderly people in nursing homes. A cross-sectional descriptive study was conducted among 151 residents aged ≥ 65 years. Data was extracted from institutional records. The mean age of participants was 86.48 ± 8.00 years; 71.5% were female. Excessive polypharmacy was observed in 49.7% of residents. The mean number of medications was 9.66 ± 4.18, with nervous system drugs being the most prescribed (3.73 ± 2.31). PDDIs were detected in 94% of the sample and PIMs were present in 82.8% of residents. The most common PIMs were proton pump inhibitors (ATC A) and anxiolytics (ATC N). Binary logistic regression identified two independent predictors for PIMs: the total number of medications (AOR = 1.259) and the use of ATC A (Alimentary tract and metabolism) medications (AOR = 2.315). Conversely, age and sex were not significant predictors. The study reveals a critical prevalence of excessive polypharmacy, PIM use, and PDDIs among institutionalized elderly in the Algarve. These findings underscore the urgent need for systematic, multidisciplinary medication reviews in Portuguese nursing homes to promote safer and more rational prescribing practices. Full article

Background and Objectives: Upper respiratory tract infections are one of the most common reasons for outpatient admission. Acute pharyngitis is typically caused by viruses and is self-limiting but in up to 30% of cases, secondary bacterial infection may occur, requiring antibacterial treatment. In the face of growing antibacterial resistance due to inappropriate systemic antibiotic use, different topical therapy would have benefits. The objective of this study was to compare changes in throat and tonsillar mucous membrane bacterial density in patients with acute pharyngitis after a single exposure to a local antibacterial agent presented in different pharmaceutical forms—medicated lozenge, throat spray, or a solution for gargling. Materials and Methods: This was a non-interventional observational study that involved 90 adult outpatients with acute pharyngitis. Patients were prescribed to one of three options: medicated lozenges (containing dequalinium chloride and cinchocaine hydrochloride)—Treatment A; throat spray (containing streptocide soluble and norsulfazol-sodium)—Treatment B; or a powder, Furasol^® 100 mg (containing furagin soluble), for use as an external gargling solution—Treatment C. Throat swab culture was collected before and 20 min after the single exposure to the medication. Microbial testing was performed using a semi-quantitative quadrant streak plate method to assess bacterial density before and after exposure. Results: Four pathogenic agents were isolated from the swabs, with Staphylococcus aureus being the most prevalent. Overall, a reduction in post-exposure bacterial growth intensity was observed in 84.6% of the samples after Treatment C exposure, with a statistically significant difference from both Treatment B (57.1%, p < 0.05) and Treatment A (10%, p < 0.05). The difference was also significant between Treatment A and Treatment B. Conclusions: The findings showed that the throat gargling solution had more impact on mucous bacterial load compared to the throat spray and medicated lozenges in the patients with acute pharyngitis. Further research should address the effects of different pharmaceutical forms of the same antibacterial agent, where available. Full article

The Internet of Medical Things (IoMT) integrates sensors, medical devices, and Internet of Things (IoT) technologies to provide data-driven healthcare systems. The systems facilitate medical monitoring and decision-making; however, there are significant concerns about data leakage and patient consent. Additionally, a shortage of large, high-quality IoMT datasets to study the surrounding issues is problematic. Federated learning (FL) is a decentralized machine learning approach that potentially offers substantial amounts of capacity, so that compound Smart Healthcare Systems (SHSs) can further personalize and contextualize the secrecy of data and strong system structures. Additionally, to protect against advanced and shifting computational intelligence-based cyber threats, especially in operational health environments, the use of Intruder Detection Systems (IDSs) is quite essential. However, traditional approaches to implementing IDSs are usually computationally costly and inappropriate for the narrow contours of deploying medical IoT devices. To address these challenges, the proposed study introduces PriFed-IDS, a novel, privacy-preserving FL-based IDS framework based on FL and reinforcement learning. The proposed model leverages reinforcement learning to uncover latent patterns in medical data, enabling accurate anomaly detection. A dynamic federation and aggregation strategy is implemented to optimize model performance while minimizing communication overhead by adaptively engaging clients in the training process. Experimental evaluations and theoretical analysis demonstrate that PriFed-IDS significantly outperforms existing benchmark IDS models in terms of detection accuracy and efficiency, underscoring its practical applicability for securing real-world IoMT networks. Full article

Background/Objectives: Despite the availability of highly effective medications, hypertension is among the most important risk factors for mortality. Because medication adherence is challenging worldwide, enhancing it to improve the prognosis of hypertension is useful. The aim of this study was to describe the prevalence of antihypertensive medication nonadherence among individuals aged 18–64 years in a deprived Hungarian population and its determinant factors, and to quantify the impact of antihypertensive medication nonadherence on premature mortality. Methods: We used data from a cohort of hypertensive individuals aged 18–64 years linked to the Health Insurance Fund’s medication purchasing data. The antihypertensive treatment adherence appropriateness (ATAP) was computed as the ratio of the observed time when a patient was properly treated to their observed survival time. ATAP was dichotomized by an observed mean of 0.872. Using adjusted odds ratios (AORs) from multivariate logistic regression models with 95% confidence intervals (CIs), we analyzed the factors influencing the mortality risk in 4962 participants over seven years of follow-up. Results: A total of 493 deaths occurred. An extremely high mortality risk was observed among patients with inappropriate adherence (AOR = 56.2, 95%CI: 41.9–75.4), which could be attributed partly to residual confounding. Significant protective factors were female sex and high education attainment. However, older age and all investigated comorbidities (diabetes mellitus, ischemic heart disease, chronic obstructive pulmonary disease, and cancer) were significantly associated with an increased risk of a lethal outcome. Similarly, smoking was also a risk factor. Conclusions: Our investigation revealed the following: (1) in the studied group of patients aged 18–64 years from an extremely disadvantaged Hungarian population, 87.2% of the person-time was covered by the appropriate redemption of medications; (2) nonadherence to medication was more common among younger adults, men, Roma people, current smokers, and COPD patients, whereas the likelihood of appropriate adherence was higher among patients with diabetes mellitus; (3) medication nonadherence was an extremely strong risk factor for a lethal outcome of HTN during the 7-year follow-up period; and (4) methods by which nonadherent patient behavior can be detected should be applied rigorously, and the detected nonadherence should be considered a signal for intervention to improve the prognosis of HTN. Full article

Frailty among older adults heightens their risk of negative health outcomes, and medication use plays a major role in this increased vulnerability. Various aspects of medication use elevate the risk of poor outcomes in individuals with frailty. The current scoping review was designed to explore medication use in older adults with frailty in primary care, focusing on the prevalence of potentially inappropriate medications (PIMs), polypharmacy, medication adherence, and their role in contributing to adverse drug events. This scoping review was conducted using the Arksey and O’Malley, supplemented by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews (PRISMA-ScR) guidelines. A search of the literature was conducted from inception to November 2023 in Ovid EMBASE, PubMed (MEDLINE), Scopus, EBSCOhost CINAHL, and Ovid International Pharmaceutical Abstracts. Studies which met the eligibility criteria included older adults with frailty (≥65 years) living at home, defined frailty criteria, and assessment of medication use. Out of the 4726 studies screened, 223 were included, conducted across 39 countries. Frailty prevalence varied widely from 0.9% to 89.2%. Polypharmacy (5–9 medications) and hyper-polypharmacy (≥10 medications) were notably more common among individuals with frailty, with polypharmacy rates ranging from 1.3% to 96.4%. Twelve studies reported PIM prevalence among individuals with varying levels of frailty, ranging from 2.4% to 95.9%. This scoping review highlights the challenges and complexities involved in understanding the relationship between medication use and frailty in older adults. Full article

Background: Vancomycin-resistant Enterococcus (VRE) has emerged as a major nosocomial pathogen. A recent surveillance of our hospital identified a concerning rise in VRE bacteremia since 2020, despite the stable use of broad-spectrum antibiotics. This trend, coupled with the increased use of daptomycin and linezolid for drug-resistant Gram-positive bacteremia (GPB), prompted an evaluation of their usage beyond approved hospital indications. Methods: A retrospective analysis was carried out from 1 February 2023 to 31 July 2023, during which 100 and 195 patients received linezolid and daptomycin, respectively. Patients’ data were extracted from the hospital’s electronic medical records, and the appropriateness of the antibiotics prescribed was assessed. The amount of daptomycin and linezolid utilization during the study period was also retrieved, as was the incidence of VRE bacteremia. Results: A total of 295 courses of VRE-active agents, linezolid (n = 100) and daptomycin (n = 195), were assessed for appropriateness in this study. Linezolid and daptomycin use were judged as inappropriate 5.0% and 9.2% of the time, respectively. The primary reason for inappropriate linezolid use was overly broad empirical therapy where first-line options like cefazolin and vancomycin could have been prescribed. Daptomycin was often used inappropriately in non-VRE infections, and surgical prophylaxis or use was extended unnecessarily without microbiological justification. Conclusions: Linezolid and daptomycin were prescribed appropriately. Nevertheless, our findings suggest the need to re-evaluate the empirical treatment strategies especially in VRE-colonized patients. Implementation of robust risk-based criteria as well as in-house hospital guidelines or protocols on the initiation of VRE-active agents may help support more judicious prescribing practices of these agents. Full article

Background/Objectives: Antibiotic resistance represents one of the major global health emergencies, driven by the inappropriate use of antibiotics and persistent misconceptions among adults attending general medical clinics. This study, conducted on 325 participants recruited from general medical clinics in the province of Salerno, aimed to assess their knowledge, perceptions, and behaviors regarding antibiotic use. Methods: A cross-sectional, quantitative observational survey was conducted using a structured questionnaire based on the WHO tool and adapted to the local context. Results: The results show that the majority of participants take antibiotics only when prescribed by a doctor (90.2%), but risky practices such as self-medication (10%) and early discontinuation of therapy (16%) persist. In addition, 72% of subjects demonstrate incomplete knowledge about the independent management of drugs, and 86% mistakenly believe that resistance is limited to the individual rather than the community. The descriptive analysis stratified by age showed higher levels of awareness among subjects under 30 years of age, compared to significant knowledge gaps and inappropriate behaviors in the over-65 age group. Conclusions: Despite a good awareness of the need for medical prescriptions and the collective importance of the phenomenon, there are still critical areas of knowledge and incorrect practices that can promote the spread of antibiotic resistance. The data collected underscore the urgency of targeted educational strategies differentiated by age group, integrated with multi-channel communication interventions, in order to promote the appropriate use of antibiotics and contain the impact of one of the most serious global health emergencies. Full article