搜索结果：Journal of pharmaceutical health care and sciences

Mobile health (mHealth) technologies are increasingly promoted as tools for chronic disease management and healthy aging, yet adoption remains persistently uneven across demographic groups. Japan, where 29.1% of the population is 65 years or older-the highest proportion globally-exemplifies the challenges of mHealth promotion in super-aging societies. Despite high smartphone penetration (90.1%) and active national digital transformation initiatives, only 21.6% of Japanese adults report regular mHealth app use, with marked disparities by age and sex. This study examined determinants of mHealth acceptance by extending the unified theory of acceptance and use of technology to incorporate eHealth literacy, self-efficacy, perceived risk, distrust, and health-related factors (health status and health interest). Age- and sex-specific differences in acceptance mechanisms were also investigated using multigroup structural equation modeling (SEM). We conducted a cross-sectional online survey in November 2023 with 960 Japanese adults sampled across 7 age strata (aged 18-27 years to aged ≥78 years). SEM tested hypothesized relationships among 9 constructs. Health status and health interest were included as observed covariates. Multigroup SEM with configural, metric, and structural invariance testing examined age- and sex-specific differences, and binary logistic regression identified predictors of current mHealth app use. The structural model demonstrated good fit (χ2/df=2.06; comparative fit index 0.953; Tucker-Lewis index 0.945; root mean square error of approximation 0.047) and explained 71.6% of the variance in behavioral intention. Effort expectancy (β=0.404), facilitating conditions (β=0.349), and performance expectancy (β=0.188) were the primary proximal predictors of behavioral intention. Social influence exerted strong upstream effects on effort expectancy (β=0.811), eHealth literacy (β=0.507), and self-efficacy (β=0.422). Health interest positively influenced performance expectancy (β=0.133), whereas neither health interest nor health status showed a significant direct effect on distrust. Distrust did not directly predict behavioral intention in the overall sample. Multigroup analyses identified 5 significant age differences and 5 sex differences. eHealth literacy increased distrust among young adults but reduced perceived risk among middle-aged and older adults. Self-efficacy negatively predicted performance expectancy among young adults yet positively predicted it among middle-aged and older adults. Distrust significantly reduced behavioral intention only among middle-aged adults. mHealth acceptance in Japan's aging society is characterized by stable proximal determinants of behavioral intention alongside heterogeneous upstream belief formation processes that vary systematically by age and sex. Health interest, rather than health status, emerged as the key contextual driver of perceived usefulness. At the theoretical level, this study clarifies how eHealth literacy, self-efficacy, and distrust function as age- and sex-contingent antecedents within an extended unified theory of acceptance and use of technology framework. At the practical level, these findings highlight the need for trust-centered, demographically tailored, and literacy-sensitive strategies to promote equitable mHealth adoption in rapidly aging societies.

Healthcare quality is an important dimension of health system performance and a key criterion for evaluating the effectiveness of China's deepening healthcare system reform. This study treats the National Comprehensive Medical Reform pilot as a quasi-natural experiment to examine its impact on healthcare quality and further analyzes the potential mechanism of pharmaceutical pricing reform. Based on panel data from 31 provinces in China from 2012 to 2020, combined with data on medical malpractice liability disputes from China Judgments Online, this study employs a multi-period difference-in-differences model to identify the policy effect of the National Comprehensive Medical Reform pilot. Healthcare quality is measured by the incidence of medical malpractice liability disputes and inpatient mortality, and the mechanism of pharmaceutical pricing reform is analyzed through changes in the structure of medical expenditures. The study finds that the National Comprehensive Medical Reform pilot significantly reduced the incidence of medical malpractice liability disputes and inpatient mortality, indicating that the reform helped improve healthcare quality. Mechanism analysis shows that the reform significantly reduced drug expenditure per outpatient visit and per inpatient admission, lowered the share of drug expenditure, and increased the share of medical service fees. These findings suggest that the National Comprehensive Medical Reform may have improved healthcare quality by reducing hospitals' dependence on drug-related revenue, increasing the relative importance of service-based income, and reshaping hospital revenue structures and provider incentive mechanisms. However, the share of examination fees increased significantly, indicating the possible presence of substitute revenue-seeking incentives and associated quality risks during the reform process. The National Comprehensive Medical Reform pilot had a positive effect on improving healthcare quality, and its mechanism may be related to hospital revenue restructuring and the optimization of healthcare service incentives induced by pharmaceutical pricing reform. Future reforms should further strengthen coordination among medical care, medical insurance, and pharmaceuticals, continue to optimize medical service pricing and compensation mechanisms, and curb substitute revenue-seeking behavior, so as to provide a more stable and sustainable institutional foundation for the continuous improvement of healthcare quality.

Inter-professional education (IPE) is recognized as best-suited strategy to improve health professionals' collaborative competencies, leading to improved patient outcomes. However, assessment of attitude of healthcare professionals towards these competencies is also important for developing effective strategies for promoting inter-professional collaboration. The present study was designed to assess IPE collaborative (IPEC) competencies of healthcare professionals including physicians, nurses and pharmacists in Pakistan. A descriptive cross-sectional study design was used to assess IPEC competencies of 500 healthcare professionals i.e. (physicians, nurses, and pharmacists) working in tertiary care healthcare facilities located in 4 cities of Pakistan were selected using convenient sampling technique. A pre-validated tool IPEC self-assessment was used for data collection. After data collection, data was analyzed statistically. The mean scores of healthcare professionals regarding IPEC Competencies were calculated for total items in which mean score of nurses was highest (67.34 ± 0.52), followed by pharmacists (66.24 ± 0.58) and then doctors (65.88 ± 0.44). The results depicted higher IPEC competencies in all the health professionals. On both the domains i.e., inter-professional values and inter-professional interaction, nurses outscored both pharmacists and doctors with mean scores 34.46 ± 0.26 and 32.88 ± 0.28 respectively. The findings indicate that healthcare professionals in Pakistan generally demonstrate positive attitudes toward inter-professional collaborative competencies, with nurses showing comparatively higher scores across both inter-professional values and inter-professional interaction domains. Although the overall competency levels were encouraging, the variation across professional groups suggests the need for more targeted efforts to strengthen collaborative practice among all disciplines. Integrating structured IPE and training into clinical and academic settings may help bridge these gaps and further enhance teamwork, ultimately supporting better patient care outcomes.

 Medicine shortages and governance failures in low- and middle-income countries continue to hinder progress towards universal health coverage.  To explore healthcare professionals' perceptions and experiences of medicines governance in South African healthcare facilities.  The study was conducted at the public healthcare sectors in Eastern Cape province, South Africa.  A qualitative exploratory cross-sectional design was used. Twenty healthcare professionals were purposively selected. Semi-structured interviews were conducted, audio-recorded, transcribed verbatim and thematically analysed using Braun and Clarke's framework.  Four major themes emerged: systemic governance constraints; pharmaceutical supply chain vulnerabilities; weak accountability mechanisms; and gaps in protocol implementation. Key determinants of medicine shortages included weak budget governance, supplier payment delays, limited pharmacy support staff and inconsistent implementation of standard treatment guidelines (STG) and limited functionality of Pharmacy and Therapeutics Committees (PTCs).  Medicine shortages result from systemic governance failures rather than isolated logistical issues. Strengthening pharmaceutical governance requires transparent budgeting, timely supplier payment systems, functional PTCs, and STG training to improve equitable access to essential medicines.Contribution: This study deepens the understanding of pharmaceutical governance, revealing systemic, interrelated factors that collectively lead to the shortage of pharmaceuticals in South Africa. Unlike previous research that focused primarily on supply chain logistics, the study showed that stock-outs were rooted not simply in operational inefficiency, but also in structural governance weaknesses. This study presents practical insights to strengthen pharmaceutical governance and supports national efforts to achieve universal health coverage by identifying specific governance obstacles and proposing system-level reforms.

Since the onset of the 2023 Israel-Gaza war, the healthcare system in the Gaza Strip has nearly collapsed. More than 70,937 casualties and 171,192 injuries have been reported, yet limited data exist on injury types and outcomes. Critical care services are essential during conflicts. This study aimed to determine causes of intensive care unit (ICU) admissions, associated injuries, complications, and outcomes in the Gaza Strip. We conducted a prospective cohort study of all adult and pediatric patients admitted to the ICUs at European Gaza Hospital and Shuhada Al-Aqsa Hospital between May 29 and June 30, 2024. Outcomes of interest were causes of admission, survival, types of complications, and length of stay. A total of 115 patients were admitted. Median age was 27 years (interquartile range 18-38), including 30 pediatric patients (26%). Thirty-five patients were female (30%). Trauma with or without burns accounted for 75 admissions (65%), while 27 (23.5%) had medical causes. Among trauma patients, 56 (75%) were from explosive injuries; traumatic brain injury was most common (30/75, 40%), including 10 of 21 pediatric trauma patients (47.6%). During ICU stay, 12 patients developed sepsis (10.6%), 10 developed septic shock (8.8%), and 12 developed multiorgan dysfunction (10.6%). Of 112 patients with known disposition, 64 were discharged and 48 died (43%). Median ICU survival was 6 days (95% confidence interval 5-17), and 17 days for pediatric patients (95% confidence interval 5-not calculable). Severe traumatic brain injury (33%) was the leading cause of death, followed by septic shock (22%). The high burden of trauma, complications, and mortality reflects the critical collapse of Gaza's healthcare system. Women and children represented a substantial proportion of ICU patients, highlighting civilian vulnerability. Urgent international medical intervention, humanitarian support, and a permanent ceasefire are essential to prevent continued loss of life.

Atrial fibrillation (AF) is the most common sustained heart rhythm disorder and is a challenging chronic disease to manage. Patients' daily self-care decisions are associated with improved AF outcomes, quality of life, and decreased hospital use and cost. However, many patients find these real-world or naturalistic decisions difficult, often because of their inherent complexity and ambiguity, coupled with the uncertainty of AF. Intervention research using technology to support AF self-care has largely emphasized making decisions with clinicians. Patients with AF are increasingly using consumer technology; yet, little is known about the use of technology by patients with AF in independent self-care decision-making. Addressing this gap will facilitate developing interventions that better leverage technology to enhance patients' naturalistic decision-making. This study aimed to explore the experiences of older adult patients in using technology to support self-care decision-making. Following an interpretive descriptive qualitative approach, older adult patients with AF were recruited from 3 specialty heart function clinics in a Western Canadian province to participate in 1 of 6 facilitated virtual focus groups for 1.5 hours. Patients were asked about their self-care decision-making since AF diagnosis, their AF-specific technology use and its use in making self-care decisions, their technology motivations, benefits, constraints, and other possibilities for use. Inductive thematic analysis was used to code the transcribed data, moving from open coding to clustering of common codes into categories, looking for patterns of meaning between and across categories to iteratively arrive at main themes and subthemes. Thirty patients (n=15, 50% women) with AF (mean age, 73, SD 5.7 years; range 63-85 years) participated in the focus groups. Participants' experiences of using technology to make daily self-care decisions were highly variable but centered on its personalized use to meet their individualized needs, preferences, and life context. The personalizing process of technology use in decision-making was characterized by three themes: (1) beginning technology use in their own times and ways, during their AF trajectory-pre-, at the time, at some point AF post diagnosis, and could be either self-initiated and/or provider recommended or influenced; (2) developing patterns of AF self-care decision-making using technology, including establishing their personal baseline, keeping out of the danger zone, watchful waiting, and seeking decision-making support; and (3) finding the place for technology in normalizing daily life, either settling on or limiting its use to normalize life. Findings expand understandings of naturalistic decision-making by elucidating the personalized process of technology use in AF self-care.

Disclosing a cancer diagnosis, particularly to individuals in family-centric cultures, is a complex process that directly impacts patient-centered care. This study explores the factors that influence attitudes toward truth disclosure of a terminal cancer diagnosis in the diverse population of the United Arab Emirates and compares these findings with practices in other nations and regions. A descriptive cross-sectional study was conducted using an online self-administered questionnaire. The questionnaire comprised 4 sections: 9 questions collected demographic data, 6 questions assessed respondents' perceptions regarding the diagnosis of terminal-stage cancer, 7 questions evaluated their perceptions of its prognosis, and 7 questions focused on their views on truth disclosure in terminal-stage cancer. The questionnaire was developed based on existing literature and expert input. The study targeted healthcare providers, as well as all students (undergraduate or postgraduate), faculty members, and staff at universities in the United Arab Emirates. Multivariate logistic regression models were applied to determine the factors influencing participants' attitudes and perceptions. A total of 495 participants were recruited, with 73.7% being female and 26.3% being male. The majority (45.9%) were aged 18 to 24 years. The average attitude scores were 87.8% for the diagnosis of terminal-stage cancer, 85.8% for its prognosis, and 69.7% for truth disclosure to family. Logistic regression analysis showed that female participants had more positive attitudes toward diagnosis (odds ratio [OR] = 1.85; 95% confidence interval [CI]: 1.1-3.1), while participants from the Middle East and North Africa had less positive attitudes toward both diagnosis (OR = 0.653; 95% CI: 0.48-0.87) and prognosis (OR = 0.652; 95% CI: 0.47-0.86). More positive attitudes toward truth disclosure were observed among participants from South Asia (OR = 1.52; 95% CI: 1.25-1.85) and Southeast Asia/Oceania (OR = 2.1; 95% CI: 1.63-2.70), as well as among nurses (OR = 5.15; 95% CI: 2.64-10.03) and Christian participants (OR = 4; 95% CI: 1.02-15.6), whereas single participants exhibited less positive attitudes (OR = 0.560; 95% CI: 0.38-0.82). These results highlight the complex interaction between cultural and demographic factors in determining perceptions of terminal-stage cancer. They emphasize the value of customized treatments and communication techniques to address different points of view, which will ultimately improve patient support and care in situations involving terminal illness.

Immune checkpoint inhibitors (ICIs) are widely used in advanced non-small cell lung cancer (NSCLC) but can lead to immune-related adverse events (irAEs) that may disrupt care. Although irAEs are well described clinically, there is limited evidence quantifying their downstream health care use and costs in Medicare beneficiaries with advanced NSCLC. To evaluate health care use and costs associated with clinically impactful irAEs among older adults receiving ICI therapy. Using Surveillance, Epidemiology, and End Results-Medicare data, we identified patients (fee-for-service beneficiaries) aged 66 to 85 years with advanced NSCLC and who initiated nivolumab, pembrolizumab, or atezolizumab, alone or in combination with each other or chemotherapy, between 2015 and 2017 (patient identification window), with follow-up through 2019. These agents represent ICIs approved for advanced NSCLC during the identification period. Clinically impactful irAEs were defined using irAE diagnosis codes accompanied by evidence of systemic immunosuppressant use and treatment interruption and were modeled as a time-varying exposure. Health care use and costs were assessed using weighted longitudinal models accounting for time-varying confounding (marginal structural models with stabilized inverse probability weights). Two-part generalized estimating equations estimated per-patient-per-month (PPPM) and cumulative outcomes over 6, 12, and 24 months, with sensitivity analyses including models incorporating ICI drug costs and alternative approaches to account for censoring. Among 4,867 patients, 1,667 (34.3%) experienced a clinically impactful irAE. Adjusted all-cause health care use was higher among patients with irAEs (mean 15.8 [SE = 0.12] vs 12.0 [SE = 0.12] visits PPPM; difference, 3.9; 95% CI = 2.9-4.8), with more than double the odds of inpatient hospitalization (odds ratio, 2.21; 95% CI = 2.15-2.29). Adjusted all-cause medical costs averaged $16,042 (SE = 14.7) vs $12,721 (SE = 13.1) PPPM (difference, $3,322; 95% CI = $3,283-$3,361), driven primarily by inpatient care ($2,922; 95% CI = $2,903-$2,941). At 24 months, cumulative costs per patients were $846,013 (SE = 12,786) for patients with irAEs compared with $751,606 (SE = 11,358) for those without (difference, $94,407; 95% CI = $91,606-$97,207). Findings were consistent in sensitivity analyses. Clinically impactful irAEs were associated with substantially higher health care use and costs among older adults with advanced NSCLC receiving ICIs, with inpatient care accounting for most excess costs. These findings have implications for managed care strategies focused on toxicity monitoring, hospitalization prevention, and value-based ICI management.

The healthcare system of Japan faces mounting challenges, including population aging, medical complexity, and workforce shortages. Hospital pharmacists are expected to ensure the safe and effective use of medicines and contribute to multidisciplinary care; however, their availability and functions remain uneven. The "Ward Pharmaceutical Care Fee I" (WardPharm-1) serves as an indicator of the implementation of advanced ward-based pharmaceutical care. This study investigated the national trends and associated factors of WardPharm-1 filing, focusing on pharmacist-to-bed ratios and hospital characteristics, to explore factors that may enable high-quality pharmacist services. We examined national open datasets from the Ministry of Health, Labor, and Welfare for fiscal years 2021-2023, linking the "List of Registered Medical Care Providers (Medical)" and the "Hospital Bed Function Report." Hospitals eligible for WardPharm-1 filing were identified, excluding psychiatric facilities and those not fulfilling minimum staffing standards. Per-100-bed staffing for eight healthcare professions and hospital bed counts were determined. Logistic regression and receiver operating characteristic (ROC) curve analyses determine the association between pharmacist staffing (Ph/100 beds) and WardPharm-1 filing, stratified by hospital type, Diagnosis Procedure Combination (DPC) group, and regional population density. Among approximately 5,800 eligible hospitals annually, 31%-34% filed WardPharm-1. Pharmacists per 100 beds (Ph/100 beds) showed the strongest association with filing (odds ratio&#x2009;&#x2248;&#x2009;1.2 yearly). Median Ph/100 beds were about 5.2 in filing hospitals and 2.6 in non-filers, with ROC cutoffs of 3.7-4.0 (AUC 0.83-0.84). Filing was most frequent in general hospitals (~&#x2009;50%) and DPC university or specified hospitals (~&#x2009;90%) and least frequent in long-term care hospitals (~&#x2009;3%) and depopulated regions (<&#x2009;25%). Adjusted analyses confirmed that Ph/100 beds remained significantly associated with filing, though effect sizes were modest. Higher pharmacist-to-bed ratios were associated with higher WardPharm-1 filing rates. Filing was more common in larger and higher-function hospitals and less frequent in smaller or lower-density settings, patterns consistent with uneven workforce distribution. Although causality cannot be inferred, pharmacist staffing levels may serve as a practical indicator related to WardPharm-1 implementation.

Non-muscle-invasive bladder cancer (NMIBC) accounts for approximately 75% of newly diagnosed bladder cancers and is particularly prevalent in men. Guidelines stratify patients into risk categories based on disease characteristics as patients often recur or progress to muscle-invasive disease. Most guidelines recommend transurethral resection of bladder tumor (TURBT) followed by up to 3&#x2009;years of Bacillus Calmette-Guerin (BCG) therapy for high-risk (HR) patients. For very HR patients or those who recur after BCG, radical cystectomy (RC) is recommended. This study aimed to describe the profile of individuals with HR-NMIBC, alongside treatment patterns and outcomes across Europe, North America, and Japan. Data were extracted from the Adelphi Disease Specific Program for 1,864 patients initially diagnosed with HR-NMIBC and 273 with very HR-NMIBC. First-line treatment was mainly intravesical BCG, however, less than half of patients received the guideline recommended maintenance BCG and none received RC. Second-line treatment options were similar to first-line, with RC usage still rare. While TURBT+BCG was shown to be the current standard of care, the underutilization of full guideline recommended treatment alongside the relatively high number of recurrences highlights the need for novel therapeutic approaches, either in combination with BCG therapy, or as alternative first-line treatments. High-risk non-muscle-invasive bladder cancer (NMIBC) is a type of cancer that has not spread into the bladder wall&#x2019;s muscle layer but is likely to spread or return after treatment. This study looked at characteristics of people with high-risk NMIBC in Europe, North America, and Japan. It also evaluated what treatments patients received. Researchers conducted a survey with doctors and patients with high-risk NMIBC to collect this information. Patient characteristics were similar across regions: 75% male with an average age of 71&#x2009;years; two out of 10 patients were in full- or part-time employment, another eight out of 10 were current or ex-smokers. Disease characteristics, including symptoms and tumor stage of included patients were representative of the general high-risk NMIBC population. Typical care was similar across regions. Most patients underwent transurethral resection of bladder tumor (TURBT) followed by insertion of Bacillus Calmette-Gu&#xe9;rin (BCG) into the bladder. TURBT is a procedure that removes cancer cells from the bladder&#x2019;s inner layers to leave the rest of the bladder intact, BCG is a live vaccine that stimulates the immune system to attack cancer cells. Fewer than half of patients continued BCG treatment for the recommended one-year maintenance period. Few patients underwent radical cystectomy, a procedure that consists in removing the bladder and nearby tissue affected by cancer. Many patients&#x2019; cancer returned within 1 year despite receiving recommended treatments. There is therefore a need for new treatments that reduce the risk of cancer returning or growing and that improve quality of life for these patients.

Cardiovascular disease (CVD) and cancer are the two leading health issues in the world, with CVD being the leading cause of death in all age groups and cancer, particularly prostate cancer (PCa), emerging as a significant concern among elderly men. Common risk factors like metabolic disorders, chronic inflammatory diseases, and hormone abnormalities have been theorized to be responsible for the increasing prevalence of these diseases. In this study, we examined the relationship between CVD and PCa, with emphasis on the pathophysiological events that connect them and how their coexistence affects patient outcomes. Common PCa treatments, such as androgen deprivation therapy (ADT) as well as androgen receptor signaling inhibitors (ARSI), have been linked to higher rates of hypertension, myocardial infarction, arrhythmias, and metabolic abnormalities. These cardiovascular side effects complicate the effective management of PCa, resulting in poorer overall results. It is essential to implement new integrated approaches to tackle these comorbid conditions. Recommendations include changes in lifestyle, personalized treatment plans, multidisciplinary collaborative efforts, and routine cardiovascular examinations for patients on PCa treatment. Evidence found that personalized exercise regimens and pharmaceutical treatments like statins and antihypertensives may lower cardiovascular risks and enhance outcomes in patients undergoing PCa treatment. Also, emerging technological interventions like wearable devices and telemedicine, such as smartwatches and mobile ambulatory blood pressure monitors (ABPMs), offer real-time cardiovascular monitoring and improve health outcomes among these patients. This study identifies the substantial gaps in clinical guidelines, notably in cardio-oncology integration, and emphasizes the importance of further research into biomarkers, shared inflammatory pathways, and individualized therapy methods. Hence, addressing these gaps will enable a more comprehensive approach to patient care, improving their quality of life and survival.

Needlestick injuries (NSIs) remain a leading occupational hazard among healthcare workers (HCWs), carrying substantial health and economic burdens. High-throughput procedural settings are particularly vulnerable, yet evidence on setting-specific interventions' effects and durability under healthcare system volatility remains limited. Existing surveillance systems for NSIs struggle to distinguish genuine risk escalation from clinical workload fluctuations. This study aims to characterize the epidemiological and economic burden of NSIs among HCWs, evaluate the effectiveness of safety interventions in the Infusion Center during post-pandemic clinical resurgence, and develop a dynamic NSIs surveillance system. A 7-year retrospective longitudinal study was conducted at a tertiary hospital across three phases: pre-, intra- and post-COVID-19 pandemic phases (P1, P2, and P3). The Infusion Center, which implemented a multi-component safety intervention bundle, served as the intervention group, with 38 other clinical departments as controls. NSIs incidence was modeled using a generalized linear mixed model (GLMM) with Poisson distribution, incorporating a department-level random intercept, a staff-size offset and hospital-wide clinical volume as a time-varying covariate. A dynamic early warning system was constructed using GLMM-derived, volume-adjusted upper control limits. The Infusion Center exhibited a 22.43-fold higher NSIs risk than controls in P1 (IRR = 22.43, p < 0.001). Controls showed a 43% reduction in P2 (IRR = 0.57, p = 0.033) followed by a rebound in P3 (IRR = 1.06, p = 0.753). Conversely, the Infusion Center showed a sustained 66% reduction in P3 relative to P1 (IRR = 0.34, p = 0.0006), significantly diverging from the hospital-wide rebound trajectory (interaction IRR = 0.32, p = 0.005). The dynamic early warning system identified 25 alarms across controls during P3, while the Infusion Center triggered zero alarms. The intervention bundle was associated with 20 fewer NSIs cases in P3, yielding a direct medical cost avoidance of 12,776.68 RMB. Systematic behavior-based interventions combining leadership accountability, competency training and continuous reinforcement are associated with a sustained reduction in NSIs risk that diverged from the post-pandemic rebound observed across control departments. The dynamic early warning system represents a proof-of-concept approach to volume-adjusted occupational safety surveillance, enabling targeted resource allocation to high-risk departments.

Oral anticoagulants, including warfarin and direct oral anticoagulants (DOACs), are widely used for the prevention and treatment of thromboembolic disorders. Community pharmacists are accessible healthcare professionals who may support safe use through counselling on adherence, interactions, adverse effects, and monitoring requirements. This study assessed community pharmacists' knowledge, attitudes, awareness, and practice-related responses regarding warfarin and DOACs and examined factors associated with knowledge scores. This cross-sectional study was conducted among community pharmacists working in the northern West Bank, Palestine, between October 2022 and March 2023. A total of 340 pharmacists were approached, and 329 completed the questionnaire (response rate: 96.8%). Data were collected using a structured 70-item questionnaire covering sociodemographic and professional characteristics, knowledge, awareness and attitudes, and practice-related items. Descriptive statistics were used to summarize participant characteristics and questionnaire responses. Knowledge scores were compared across subgroups using Mann-Whitney U and Kruskal-Wallis tests, and multivariable linear regression was used to examine independent associations with knowledge scores. A p value&#x2009;<&#x2009;0.05 was considered statistically significant. The study included 329 pharmacists with a mean age of 33.64 years; 70.5% were women and 80.9% held a bachelor's degree in pharmacy. Warfarin (Coumadin 5&#xa0;mg) was available in 87.8% of participating pharmacies. Across knowledge items, 49.1% of responses were correct. Only 48.6% correctly recognized that missing a single DOAC dose could worsen a patient's condition, and 49.2% selected "do not know" regarding the interaction of apixaban or rivaroxaban with St. John's wort. For warfarin, 84.8% recognized potential dietary interactions and 84.2% recognized the importance of international normalized ratio (INR) monitoring, whereas only 35.3% identified vitamin K as a reversal option for excessive warfarin anticoagulation or bleeding. In univariable analyses, no statistically significant differences in knowledge scores were observed according to sociodemographic or professional characteristics (all p&#x2009;>&#x2009;0.05). Consistent with these findings, the multivariable model was not statistically significant, and no independent predictors of knowledge score were identified. Community pharmacists in the northern West Bank showed suboptimal knowledge regarding oral anticoagulants, with important gaps related to DOAC reversal agents, drug and herbal interactions, and missed-dose counselling. No independent predictors of knowledge score were identified, suggesting that educational needs are broadly distributed among pharmacists. Targeted continuing education focused on practical anticoagulant counselling and medication-safety issues may strengthen pharmacists' contribution to safer oral anticoagulant use.

Out-of-pocket (OOP) cost is routinely captured by payers and health systems and may help identify individuals at risk of cost-related care avoidance. This study aimed to evaluate the relationship between OOP cost burden relative to household income (OOP:HHI) and cost-related care avoidance and to assess whether this relationship differs by cancer history. A retrospective cross-sectional study was conducted leveraging data from multiple survey waves of the Understanding America Study (2015-2024). Adults aged &#x2265;18 years with data on OOP health care expenditure, household income, and cost-related care avoidance were included. Mixed-effects logistic models with random intercepts were used to assess associations between OOP:HHI and care avoidance, adjusting for respondent characteristics. Effect modification by cancer history was examined. Classification performance of OOP:HHI alone versus multivariable models was evaluated using receiver operating characteristic curves. The analysis included 21,299 responses from 10,811 respondents, of which 2180 responses were from 1052 respondents with cancer history. Higher OOP:HHI was independently associated with increased odds of cost-related care avoidance (adjusted odds ratio per 1% increase&#xa0;=&#xa0;1.03; 95% CI, 1.02-1.04) with similar trends in both cancer and noncancer subgroups. OOP:HHI alone showed modest discrimination, whereas multivariable models demonstrated excellent performance in identifying respondents who indicated care avoidance. Higher OOP cost burden was associated with cost-related care avoidance regardless of cancer history, but cost burden alone was insufficient for&#xa0;risk identification. Integrating OOP costs with routinely available patient characteristics may better identify individuals at risk of care avoidance for targeted interventions to mitigate financial toxicity.

Health-related quality of life (HRQoL) data among patients with breast cancer (BC) in Malaysia remain limited. This study aimed to describe HRQoL and identify its key predictors to inform future health policy planning. A cross-sectional survey was conducted between April 2023 and January 2025 among BC outpatients in eight public specialist hospitals in Malaysia. Sociodemographic and clinical data were collected alongside patient-reported outcome measures, including the EuroQol-5 Dimension 5-Level questionnaire (EQ-5D-5L), a preference-based health utility measure, and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), a cancer-specific HRQoL questionnaire. Multivariable linear regression models were used to identify independent predictors of HRQoL for each instrument. The mean (standard deviation) EQ-5D-5L health state utility value (HSUV) was 0.853 (0.179), the mean EQ-VAS score was 79.2 (19.1), and the mean (standard deviation) EORTC QLQ-C30 summary score was 83.3 (15.3). The EQ-5D-5L dimensions with the highest prevalence of reported problems were pain/discomfort and anxiety/depression. The EQ-5D-5L HSUV and VAS score demonstrated moderate to strong positive correlations with the EORTC QLQ-C30 summary score (&#x3c1;&#x2009;=&#x2009;0.503 to 0.672, p&#x2009;<&#x2009;0.001). In multivariable analysis, advanced cancer stage, Chinese ethnicity, and lower education were independently associated with poorer EQ-5D-5L HSUV. EQ-VAS scores were associated with Indian ethnicity and completion of the questionnaire in English. For EORTC QLQ-C30, advanced cancer stages and Chinese ethnicity remained significant predictors. HRQoL among patients with BC in Malaysia was primarily influenced by cancer stage, ethnicity, and education level. Advanced cancer stage was consistently associated with poorer patient-reported outcomes. The complementary use of EQ-5D-5L and EORTC QLQ-C30 provides more comprehensive estimates to inform survivorship care and future economic evaluations.

The 2019 medication regimen complexity-intensive care unit (MRC-ICU) score is associated with patient outcomes, ICU complications, and critical care pharmacist workload. This score was developed using heuristic component selection and validated in a single-center cohort of 130 ICU patients. We sought to apply data-driven reweighting methodology in a large, multicenter cohort of ICU adults to improve the predictive capabilities of MRC-ICU. This was a retrospective, observational cohort study of adults admitted to an ICU between 2015 and 2023 at two academic health systems. Machine learning-based methods, including Principal Component Analysis and Random Forest, were used to create an updated MRC-ICU score optimized to predict three outcomes: hospital mortality, ICU fluid overload (FO) occurrence, and invasive mechanical ventilation (IMV) use. MRC-ICU 2.1 used average mortality, FO, and IMV use; MRC-ICU 2.2 used average mortality and FO and adjusted for prolonged IMV use. Data from one center were used for training and testing, and data from the other for validation. The predictive abilities of MRC-ICU 2.1 and 2.2 for each outcome were compared to MRC-ICU 1.0 and to severity of illness scores (i.e., Acute Physiology and Chronic Health Evaluation [APACHE] II and Sequential Organ Failure Assessment [SOFA]). A total of 19,117 patients across training, testing, and validation datasets were included. MRC-ICU 2.0 scores outperformed MRC-ICU 1.0 for predicting most outcomes, with improvements in Area Under the Receiver Operating Characteristic (AUROC) ranging from +0.03 to +0.08 across datasets. MRC-ICU 2.1 and 2.2 did not consistently outperform APACHE II and SOFA in predicting mortality. The addition of MRC-ICU 2.0 scores to models including APACHE II or SOFA resulted in statistically significant improvements in discrimination in several settings (DeLong p&#x2009;<&#x2009;0.05), with AUROC increases generally ranging from approximately +0.01 to +0.13 depending on outcome and dataset. The updated MRC-ICU 2.0 score (MRC-ICU 2.1 and 2.2) demonstrated consistently improved discrimination compared with the original MRC-ICU 1.0 across outcomes and datasets. The performance of MRC-ICU 2.0 (MRC-ICU 2.1 and 2.2) was generally comparable to established severity-of-illness scores (SOFA and APACHE II), although it did not consistently outperform these measures. When incorporated into combined models, MRC-ICU 2.0 provided additional predictive value, indicating that it captures information complementary to traditional severity-of-illness scores. Overall, these findings suggest that MRC-ICU 2.0 represents an improved and clinically interpretable measure of medication regimen complexity that is useful as a complementary predictor.

Ulcerative colitis is a chronic inflammatory disease affecting the colon and rectum. We aimed to investigate the efficacy and safety of duvakitug, an anti-TNF-like cytokine 1A (TL1A) monoclonal antibody, in adults with moderately to severely active ulcerative colitis. In this multicentre, placebo-controlled, phase 2b study, we randomly assigned (1:1:1) adults aged 18-75 years with moderately to severely active ulcerative colitis (including patients with inadequate response, loss of response, or intolerance to previous conventional or advanced therapies) to receive a 2250 mg loading dose of duvakitug (subcutaneously), followed by either 450 mg or 900 mg doses every 2 weeks, or placebo loading dose followed by placebo every 2 weeks. The primary endpoint was clinical remission (modified Mayo score) at week 14, analysed using Bayesian methodology. A duvakitug dose was declared successful if the posterior probability that the response rate exceeded placebo was 0&#xb7;90 or greater. Analyses were done in the modified intention-to-treat population, which included all patients who received at least one dose of their assigned treatment. This trial was registered with ClinicalTrials.gov, NCT05499130, and has been completed. Patients were enrolled between Sept 30, 2022 and Nov 12, 2024. We screened 260 patients with ulcerative colitis. Of these, we randomly assigned 137 (53%) patients to receive duvakitug (n=47 450 mg and n=46 900 mg) or placebo (n=44; modified intention-to-treat analysis set). Patients had a mean age of 41&#xb7;0 years (SD 13&#xb7;1); 86 (63%) were men, 51 (37%) were women, and 132 (96%) were White. 43 (31%) patients had previous exposure to an approved advanced therapy. 17 (36%) of 47 patients in the duvakitug 450 mg group and 22 (48%) of 46 patients in the duvakitug 900 mg group were in clinical remission at week 14, compared with nine (20%) of 44 patients in the placebo group. Differences in posterior mean response rates versus placebo were 15% (95% credible interval [CrI] -3 to 33) for duvakitug 450 mg and 26% (95% CrI 8 to 44) for duvakitug 900 mg, with posterior probabilities of superiority to placebo exceeding the prespecified threshold for declaring efficacy (0&#xb7;95 in the 450 mg group and >0&#xb7;99 in the 900 mg group). Adverse event incidence was similar with duvakitug (23 [49%] of 47 patients in the 450 mg group and 20 [43%] of 46 in the 900 mg group) and placebo (23 [52%] of 44). The most frequently occurring adverse events were anaemia (one in the 450 mg group, one in the 900 mg group, and three in the placebo group) and upper respiratory tract infection (three in the 450 mg group, one in the 900 mg group, and one in the placebo group). One serious adverse event occurred in the 900 mg group (non-infective oophoritis) and one in the placebo group (intracranial haemorrhage). Duvakitug showed significant evidence for clinical remission versus placebo, with no safety concerns identified, in patients with moderately to severely active ulcerative colitis. Teva and Sanofi.

The coronavirus disease 2019 (COVID-19) pandemic highlighted the influence of behavioral and environmental factors on the risk of infection, as well as on disease progression and severity. Therefore, it is critical to improve public health knowledge regarding the factors influencing disease outcomes. This study describes the development and validation of the "Cuban population environmental and lifestyle factors Questionnaire" (CELF-Q), a tool designed to evaluate the impact of environmental and lifestyle factors on COVID-19 outcomes in the Cuban population. Based on an existing lifestyle questionnaire developed for the Latin American population, a thorough process of modification, cross-cultural adaptation, and iterative desk review was conducted to generate the CELF-Q. Pre-test analysis was performed to assess face and content validity. To evaluate content validity, a panel of 15 experts was selected. Test-retest reliability was assessed in 60 participants, while internal consistency was evaluated by administering the questionnaire to 309 individuals with SARS-CoV-2 infection. Confirmatory factor analysis (CFA) was performed to assess the fit of the CELF-Q's factor structure. The content validity of the questionnaire was deemed "acceptable" across several dimensions, based on the results of the content validity ratio (CVR), content validity index (CVI), and Aiken's validity (V). Only a few items were identified for revision using these quantitative measures. Additionally, the experts supplemented the evaluations with qualitative comments for the modification of the questions. The test-retest reliability analysis showed an overall mean kappa coefficient of 0.89 [standard deviation (SD): 0.21] and a mean overall correlation coefficient of 0.99 (0.02), indicating high to almost perfect agreement. An internal consistency analysis showed that the majority of the dimensions had acceptable Cronbach's alpha values. In particular, the self-care behavior, socioeconomic restrictions, and diet and nutritional habits dimensions achieved respectable Cronbach's alpha values (between 0.7 and 0.8). The generated CELF-Q is a comprehensive, valid, and reliable tool for obtaining information on environmental/lifestyle factors associated with SARS-CoV-2 infection, as well as the development and severity of COVID-19, in the Cuban population.

To estimate the effect of hospital-physician vertical integration on utilization-driven annual healthcare spending for an all-payer cohort of patients with multiple chronic conditions. We used a quasi-experimental difference-in-differences with staggered adoption approach to estimate the effect of hospital-physician vertical integration on total annual utilization-driven spending per patient (primary outcome). We also examined changes in annual inpatient, outpatient, professional, and pharmaceutical utilization-driven spending (secondary outcomes). Using 2016-2021 Virginia all-payer administrative claims data, we conducted a retrospective analysis of 77,248 patients aged 45-99, with Medicare, Medicaid, and/or commercial insurance, and at least two qualifying chronic conditions at the beginning of the study period. The treatment group included patients of physicians who began the study period independent and became integrated in 2018, 2019, 2020, or 2021, respectively. The control group included patients of physicians who remained independent during the entire study period. While we found no significant difference in utilization-driven spending after integration overall ($1063, CI: $-364 to $2414), meaningful heterogeneity emerged across the staggered integration cohorts. Notably, when excluding the 2021 integration cohort (which exhibited significantly lower total annual utilization-driven spending), we found evidence of substantially higher annual total ($1750, CI: $207 to $3739) and inpatient ($898, CI: $65 to $2293) spending after integration among the earlier integration cohorts, driven by inpatient utilization. These findings held when limiting our analyses to patients of primary care physicians. This study provides evidence that the timing of hospital-physician vertical integration (pre-pandemic versus pandemic-era), particularly among primary care physicians, drove heterogeneous treatment effects in utilization-driven spending for the growing population of adults living with multiple chronic conditions.