Community-based medical education and research services (COBMERS) place medical students in primary health care facilities to strengthen their skills in community health service delivery, teamwork, leadership and professional ethics within limited-resource settings. Beyond training, COBMERS enables universities to generate evidence on local disease epidemiology, transmission dynamics, and control practices, resulting in a tangible, contextualized impact on the communities. There is however limited data on disease profile in Teso subregion, with limited epidemiological research in the area. This prospective study aims to profile the disease burden in the Teso subregion through COBMERS, thereby informing community-level interventions and health policy. The study will employ convergent parallel mixed-methods design, integrating quantitative and qualitative approaches. Quantitative components will include cross-sectional surveys to determine prevalence of non-communicable diseases (NCDs), neglected tropical diseases (NTDs), and infectious diseases, complemented by prospective cohort studies to assess temporal trends. Qualitative data will be gathered through focus group discussions and key informant interviews to explore community perceptions, health system capacity, and effectiveness of preventive measures. A community-based participatory research (CBPR) approach will guide all phases, ensuring that research is co-designed with community members, health practitioners, and local authorities. Medical students, under the supervision of faculty and site mentors, will serve as primary data collectors, integrating research with their COBMERS training. The study is expected to provide evidence on the prevalence, trends, and risk factors of major diseases in the Teso subregion, alongside community perspectives on health priorities and barriers to care. Findings will stir up debates to inform tailored interventions, strengthen primary health care, and guide policy formulation. Additionally, embedding research within COBMERS is expected to build local research capacity among site mentors and students, fostering sustainability and continued community-university collaboration. This protocol therefore provides an integrated framework that combines epidemiological surveillance, community engagement, and capacity building. By leveraging COBMERS and CBPR, the study seeks to provide actionable evidence to reduce the burden of NCDs, infectious diseases, and NTDs while promoting health system resilience in Eastern Uganda.
Photovoice is a community-based participatory research methodology that empowers participants to document and reflect on their lived experiences through photography. This scoping review examines the use of Photovoice in obesity research to explore the contexts in which it has been used, its application, and key themes in the literature to date. Eligible studies were peer-reviewed primary research published since 1997 that used Photovoice (with the process described) to collect empirical data from people with lived experience of obesity as the primary focus and were available in English, French, or Portuguese. Following the Joanna Briggs Institute guidelines, a systematic search was conducted in six databases, yielding 387 records, with 32 studies meeting the inclusion criteria. Key data, including study location, participant demographics, Photovoice methodology, and findings, were extracted and synthesized. Most studies were conducted in North America within community settings, predominantly with minority populations. Four key themes emerged: environmental influences, facilitators and barriers to healthy living, mental health and well-being, and perceptions of obesity. Although findings align with other research methodologies, Photovoice uniquely highlights participant voices and fosters critical community engagement. Photovoice is a valuable tool for obesity research, amplifying participant perspectives and contextual insights in ways more traditional methods may overlook. Future research should expand geographic and demographic diversity and adapt Photovoice for virtual formats to broaden its accessibility and explore its impact on participants, policy, and practice change.
The synthesis of psychopharmaceuticals in the twentieth century marked the beginning of modern psychopharmacology, replacing earlier first-line psychiatric management that relied on psychosurgery, physical restraint, or administering narcotics and sedatives, e.g., morphine and chloral, which suppressed psychotic outbreaks temporarily without addressing the origin. Chlorpromazine's effective management of psychosis in the early 1950s opened the door for non-surgical therapies, making psychopharmaceuticals the current first-line treatment. While modern psychopharmacology began in the 1950s, the history of psychopharmacology may extend back many years. The concept of treating patients by understanding the cause and healing the mind was also evident during the Islamic Golden Age (ninth to thirteenth century CE). One of the physicians in the field was Rhazes (865-925 CE), also known as Abu Bakr Muhammad ibn Zakariyya Al-Razi. Rhazes' contributions to both psychiatry and pharmacology make his work a subject for examining the roots of psychopharmacology. This study aims to explore Rhazes' pharmacological approaches for patients with mental illnesses, focusing on the conditions under which he prescribed herbs for neurological, psychological, and psychiatric issues. An analytical approach has been utilized to systematically extract data from Al-Hawi and Liber Almansoris concerning neurological, psychological, psychiatric, and behavioral conditions. For the next phase, another table was created to list each condition alongside its treatment and psychopharmacological classification based on the works of Rhazes. Based on the collected information from Rhazes' Al-Hawi and Liber Almansoris, each of the mentioned neurological, psychological, psychiatric, and behavioral conditions was categorized. Rhazes distinguished between different psychological conditions and avoided using a universal prescription. He also differentiated between conditions that necessitated pharmacological interventions and those that could be effectively addressed through lifestyle modifications, nutritional adjustments, or manual therapy (hands-on therapy techniques like massage for managing musculoskeletal problems). The current historical study indicates that the roots of psychopharmacology can be traced back to the ninth century, during which the physician Rhazes documented various psychological and psychiatric diseases in his works Al-Hawi and Liber Almansoris, along with their natural pharmacological treatments. This historical perspective can enhance our understanding of psychopharmacology and provide new insights for expanding the range of psychopharmacological agents. Clinical trial number: Not applicable.
Liparis nervosa (Thunb.) Lindl. (L. nervosa), a species belonging to the genus Liparis within the Orchidaceae family, is known as "Jian-Xueqing" or "Jian-Xueqin" in traditional Chinese medicine (TCM). This plant has a long history of medicinal use in TCM, valued for its diverse therapeutic properties for treating hemoptysis, hematemesis, cough due to lung heat, rheumatic arthralgia, infantile convulsions, and abscesses. Externally, it is applied for traumatic bleeding, boils, contusions, dermatitis, and snakebites. However, no systematic review of L. nervosa has been reported so far. This paper aims to provide a comprehensive review of the research progress on L. nervosa regarding its botany, traditional uses, phytochemistry, pharmacological activities, toxicology, and clinical applications. By bridging traditional knowledge with modern scientific evidence, this review seeks to offer new perspectives for future research of L. nervosa. This paper uses "Liparis nervosa", "Jian-Xueqing" and "Jian-Xueqin" as the keywords to conduct all the relevant information from PubMed, Web of Science, SciFinder, CNKI, China Master's Doctoral Thesis, Wanfang, Google Scholar, and ancient books. We retrieved all literature (in Chinese and English) from the establishment date of the database up to February 2026, including articles, reviews, master's thesis, doctoral thesis, and technical reports, while excluding literature unrelated to L. nervosa. In total, 150 compounds have been isolated and identified from L. nervosa, including 36 benzoic acid derivatives, 27 alkaloids and their derivatives, 24 phenanthrenes, 21 phenylpropanoids, 7 flavonoids, 7 steroids and triterpenoids, 11 fatty acid derivatives, and 17 other compounds so far. Pharmacological studies have demonstrated that extracts and compounds derived from L. nervosa exhibit a broad range of bioactivities, such as hemostatic, anti-inflammatory, antinociceptive, antitumor, antioxidant, antibacterial, hypolipidemic, and immunosuppressive effects. In safety evaluations, no adverse effects or toxic activities were observed in acute toxicity studies. This review summarizes the recent advances in the phytochemistry, pharmacology, and clinical potentials of L. nervosa, and systematically categorizes its structure-activity-mechanism relationship. As a valuable traditional herb, L. nervosa contains diverse chemical constituents and exhibits various bioactivities. Several of its traditional uses have been supported by modern pharmacological research. However, most studies have been conducted only at the cellular and animal model levels, lacking more robust evidence from clinical studies. Furthermore, systematic safety data on L. nervosa are severely lacking. Further research is needed to elucidate the pharmacological mechanisms and ensure safe clinical applications. Moreover, as a valuable and endangered species, future investigations should focus on the cultivation techniques, product development, and sustainable utilization.
Environmental cleanup processes take place after contamination and possible human exposure to a range of pollutants. Researchers often contribute significantly in developing knowledge to assist remediation efforts; however, their work has sometimes been critiqued as "helicopter research" that does not benefit communities. This study aimed to develop a social responsibility tool that promotes the social impact of research conducted at cleanup sites. We used a qualitative case study approach to understand perspectives of stakeholders working at a contaminated site called Jones Road in Houston, Texas. Data collection included ongoing participant observation at community events and semi-structured stakeholder interviews, consisting of fifteen exploratory interviews followed by nine interviews to validate the tool. We analyzed interview data using both inductive and deductive approaches to design a preliminary social responsibility tool that was later refined and validated. Our tool is intended to help researchers map out stakeholder needs, develop goals that align with those needs, identify their responsibilities to effectively engage with and benefit stakeholders, and evaluate social benefits. Notably, we provide reflexive questions to assist researchers to enable advocacy, share expertise, develop knowledge, manage the harms of science, ensure safety, increase transparency, and ultimately build lasting relationships.
Recent clinical trials have suggested the safety and efficacy of psychedelic therapy for treatment-resistant depression, posttraumatic stress disorder, addiction, and end-of-life distress. While neurobiological mechanisms such as 5-HT2A receptor activation, increased neural entropy, and default mode network modulation have been well-characterized, significantly less attention has been given to the emergence of unconscious material within psychedelic states. This article introduces a psychodynamically informed framework for understanding and working with such material in clinical contexts. Drawing on psychoanalytic theory, we explore how psychedelic compounds may facilitate access to preverbal, dissociated, and developmentally embedded psychic content, often expressed through somatic experience, symbolic imagery, and unconstrained affect. Using the four standard phases of psychedelic screening, preparation, psychedelic treatment session, and follow-up or integration, we present a structured psychodynamic lens, integrating conceptual theory with illustrative clinical vignettes. These fictional composites, informed by publicly funded clinical research programs, highlight how unspoken experience, affective intensity, and shifts in psychic structure may unfold within the psychedelic experience. We argue that consideration of unconscious communication, symbolic processes, and defensive functioning can foster greater clinical depth. This article advances the position that psychoanalytic models, though underrepresented in current psychedelic research, offer valuable tools for conceptualizing mechanisms of change beyond symptom reduction. As psychedelic treatments approach regulatory approval and broader clinical use, such perspectives may play an important role in future research, training, supervision, and individualized care models.
Assess the implications of Ministerial Decree (MD) 77/2022 in Italy, which decentralizes healthcare through proximity-based models, from the perspective of key actors involved, and discuss its relevance to sustainability and value assessment. A cross-sectional survey was conducted with four stakeholder groups: pharmaceutical companies, scientific societies, Health Economics and Outcomes Research (HEOR) experts, and patient advocacy organizations (N = 162). Structured questionnaires examined awareness/knowledge, perceived implementation, perceived impact, operational feasibility, and policy alignment. Over 60% of respondents recognized the strategic value of proximity care. Key barriers included administrative burden (47%), resource constraints (38%), and lack of Key Performance Indicator (KPI)-based frameworks (55%). Treatments in oncology, geriatrics, and metabolic diseases were considered most suitable for decentralized provision. Divergent perspectives emerged professional stakeholders emphasized methodological rigour and outcome monitoring, while patient organizations foregrounded equity of access, responsiveness, and patient-facing feasibility. MD 77/2022 opens a policy window to align decentralized care pathways with sustainability and value assessment. However, the survey did not collect empirical pricing, reimbursement, or cost-effectiveness data; therefore, any implications for pricing governance should be interpreted as conceptual and hypothesis-generating rather than as demonstrated effects. Heterogeneous implementation and fragmented outcome measurement remain the primary barriers; a minimum viable KPI set and routine data infrastructure are prerequisites for translating perceived value into decision-relevant evidence.
As medical cannabis gains wider legal and social acceptance in the U.S., understanding its perceived benefits, risks, and patterns of use among cancer survivors, as well as healthcare providers' perspectives, is critical for informing clinical care and improving patient-provider communication. We conducted parallel surveys of cancer survivors (n = 395) and cancer care providers (n = 62) to assess convergent and divergent attitudes, as well as perceived benefits and risks of cannabis. Among survivors, subgroup analyses by cannabis use status (cannabis users vs. never users) examined differences in healthcare utilization, satisfaction, quality of life, mental health, and risk behaviors (e.g., smoking and alcohol use). Overall, attitudes toward medical cannabis were similar across groups; however, providers (25%) were more aware of risks than survivors (8.4%; χ²=13.37, p< .01). Survivors (68.5%) were more comfortable discussing cannabis with providers than providers (46.7%) were with patients (χ²=35.20, p< .01), and providers held more negative views of recreational cannabis (t = 2.20, p=.03). Among survivors, cannabis users (vs. never users) reported higher social well-being but lower physical and emotional well-being, greater healthcare mistrust, and lower healthcare utilization (all ps< 0.05). Compared to non-cannabis using cancer survivors, cannabis-using survivors had higher rates of smoking, vaping, anxiety, and depression, with no differences observed in chronic pain, alcohol use, or sleep quality. These findings highlight gaps in risk awareness and communication between survivors and providers. Improving care will require open, nonjudgmental dialogue supported by clear clinical guidance, along with further research on the long-term and cancer-specific effects of cannabis use.
Late-life depression (LLD) (depression occurring in individuals aged ≥ 65 years) often goes underdiagnosed and undertreated. Pharmacists who conduct medication reviews may play a significant role in LLD screening. This study aimed to explore healthcare professionals' (HCPs) perspectives regarding the role of pharmacists in LLD screening for older adults during medication reviews. A semi-structured interview guide was developed, guided by the Theoretical Framework of Acceptability (TFA). HCPs across Australia were recruited via purposive sampling through professional organisations' social media and e-newsletters distributed by primary health networks, and via convenience sampling through departmental meetings and emails at Royal North Shore Hospital, New South Wales, Australia. The interviews explored HCPs' acceptability and perspectives regarding the role of pharmacists in LLD screening. Key themes and subthemes were identified using inductive thematic analysis. Each subtheme was then deductively mapped to the TFA constructs. Twenty-eight HCPs participated in the interviews, including 10 credentialed pharmacists (35.7%), nine hospital pharmacists (32.1%), five geriatricians (17.9%) and four general practitioners (14.3%). Most participants were female (n = 22; 78.6%) and practising in New South Wales, Australia (n = 17; 60.7%). The duration of interviews ranged from 21 to 55 min (M = 33 min, SD = 9 min). Five key themes were identified, including Considerations for service delivery, Patients' homes as screening setting, Resource requirements, Timely follow-up, and Benefits of screening. These themes were further divided into eight subthemes. HCPs generally viewed pharmacist-delivered LLD screening as acceptable, provided certain factors were addressed prior to implementation. Facilitators such as increased patient comfort in their homes and the importance of mental health training were noted; however, barriers such as time constraints, lack of remuneration for additional services and the difficulties of timely follow-up may impede the provision of such services. HCPs were generally accepting of pharmacist-delivered LLD screening during medication reviews, and perceived pharmacists to have a role in such services. Recommendations for future implementation include targeted mental health training for credentialed pharmacists, appropriate remuneration, and timely follow-up pathways for at-risk patients.
Treatment of chronic inflammatory diseases has been revolutionized with the introduction of targeted therapies using therapeutic antibodies. However, a large proportion of patients do not respond to treatment, or they lose response over time. To overcome this challenge, researchers have started to investigate strategies for treatment optimization, based on the development of patient stratification tools and therapeutic drug monitoring (TDM). The aim of the COST Action European Network on Optimizing Treatment with Therapeutic Antibodies in chronic inflammatory diseases (ENOTTA) is to create an interdisciplinary, pan-European network to defragment and structure scientific research in this field. Through the network, ENOTTA will facilitate the implementation of tools for patient stratification, as well as individualized (TDM-guided) approaches. These strategies should be cost-effective and provide therapeutic antibody treatment optimization for the treatment of chronic inflammatory diseases. This article highlights the key achievements of the ENOTTA consortium to date.
Intestinal diseases, including inflammatory bowel disease, functional bowel disorders, stress-related enteropathy, colorectal cancer, and colitis-associated colorectal cancer, share overlapping pathological processes such as epithelial barrier disruption, immune dysregulation, microbiota imbalance, oxidative stress, and inflammation-driven tissue injury. Paeoniflorin, a major monoterpene glycoside derived from Paeonia species, has attracted increasing attention because of its anti-inflammatory, antioxidant, immunomodulatory, anti-apoptotic, and barrier-protective properties. This review summarizes experimental evidence and mechanistic findings regarding the therapeutic potential of paeoniflorin in intestinal diseases. Current preclinical studies suggest that paeoniflorin can alleviate colitis, improve epithelial barrier integrity, promote mucosal repair, modulate microbiota-metabolite interactions, reduce visceral hypersensitivity, and suppress inflammation-associated colorectal tumorigenesis. Mechanistically, these effects involve coordinated regulation of inflammatory signaling, immune-cell balance, epithelial regeneration, gut-brain axis-related pathways, and oncogenic inflammatory cascades. Recent advances in colon-targeted delivery, pharmacokinetic modulation, compatibility-dependent exposure, and derivative development further support its translational potential. However, existing evidence remains largely based on in vitro and animal studies, with limited clinical data, heterogeneous models and dosing regimens, insufficient PK/PD validation, and unresolved druggability challenges. Future research should integrate mechanistic validation, optimized delivery systems, exposure-response evaluation, and clinically relevant disease stratification to support its progression from a bioactive natural compound to a viable intestinal therapeutic candidate.
Glial-mediated neuroinflammation significantly contributes to major neurodegenerative disorders such as Parkinson's disease, Alzheimer's disease, Huntington's disease, multiple sclerosis, and amyotrophic lateral sclerosis. Inhibition of glial-mediated neuroinflammation is effective in treating neurodegenerative diseases. Although no permanent cure exists, considerable research aims to identify natural compounds that may slow the disease progression. Icariin is a naturally occurring flavonoid derived from the herb Herba epimedii and has been shown to have several medicinal benefits, including anti-aging, antioxidant, anti-inflammatory, and anti-apoptotic properties. Recent studies have indicated that Icariin, a potent prenylated flavonol glycoside, exhibits neuroprotective effects against glial-mediated neuroinflammation. Icariin attenuates glial pro-inflammatory responses and prevents neurotoxicity in cellular and animal models. Additionally, Icariin is speculated to facilitate neuronal functioning and survival in experimental conditions. The present review highlights the remarkable role of glial cells in neuroinflammatory processes subsequently neurodegeneration, and the potential of icariin to suppress glial-mediated neuroinflammation. We hope that this review will accelerate the pharmacological development of icariin as a potential therapeutic compound against glial-mediated neuroinflammation, which triggers the pathogenesis of several neurodegenerative disorders.
This review provides an exhaustive overview of the main cervid species in Europe, including the red deer (Cervus elaphus), roe deer (Capreolus capreolus), fallow deer (Dama dama), moose (Alces alces) and reindeer (Rangifer tarandus) regarding the geographic distribution of the species, population trends, habitat preferences, and key biological traits. The review focuses on the environmental factors that influence the well-being of cervids, such as habitat quality, competition, food availability, climate change, contamination and anthropopression. Cervids are considered effective bioindicators of ecosystem stability and environmental contamination due to their status as large herbivores with wide-ranging territories and sensitivity to biotope changes. In addition, the impact of perfluoroalkyl and polyfluoroalkyl substances (PFAS) and polychlorinated biphenyls (PCBs) on the well-being of this taxonomic family is characterized. It is imperative to emphasize the significance of incorporating prey, predators, and humans as a comprehensive ecosystem within which cervids reside. The significance of habitat sharing is well documented, particularly in regard to the definition of predator-prey mechanisms. The insights derived from this research are of particular relevance when seeking to define solutions that optimize human-wildlife coexistence, especially within the context of European highly anthropogenic systems. The review concludes with a view on future perspectives for cervid well-being in Europe and emphasizes the necessity of sustainable land use, pollution mitigation, and the establishment of conservation programs for cervid populations and the ecosystems they represent. Effective management requires long-term monitoring, including significant fluctuations and behaviour of the species.
Methamphetamine use is a growing concern, particularly among individuals experiencing homelessness or living in permanent supportive housing (PSH). While evidence-based treatments such as contingency management (CM) and the community reinforcement approach (CRA) exist, little is known about their implementation and adaptation in PSH. Semi-structured interviews were conducted with 25 PSH residents using methamphetamine in Seattle, Washington (May-July 2022). Thematic analysis using the Consolidated Framework for Implementation Research identified barriers, facilitators, and adaptations for CM and CRA. Residents expressed interest in CM and CRA, citing knowledge/beliefs about the interventions, implementation climate, and tension for change as facilitators. Barriers included resource availability and staff capacity. Residents suggested adapting CM by incentivizing diverse behaviors and tailoring CRA to prioritize recreational and social activities. Adapting CM and CRA in PSH could address needs of residents using methamphetamine but addressing social determinants and resource limitations is crucial.
Chronic diseases place a growing burden on health systems and require effective strategies to support long-term medication use. Medication Therapy Management (MTM) has been shown to improve clinical outcomes in chronic disease care, but its implementation depends on pharmacists' competencies and access to structured training. In Indonesia, MTM remains inconsistently implemented in primary healthcare centers (PHCs), and pharmacists have reported competency gaps in the absence of standardized training. Evidence to inform context-specific training design is limited. The objective of this study was to explore and identify Indonesian PHC pharmacists' perspectives on training for chronic-disease MTM, including their needs, preferences, perceived challenges, and facilitators. This paper reports the qualitative component of a larger mixed-methods study. A qualitative descriptive study was conducted using six focus group discussions (FGDs) with 32 PHC pharmacists from 32 provinces in Indonesia. Participants were purposively selected based on their experience in PHCs (≥ 6 months). All audio recordings were transcribed verbatim and then analyzed using an inductive thematic approach in Atlas.ti. To strengthen the credibility of the findings, we used triangulation, member checking, and peer debriefing during the analysis. The analysis generated four themes: needs, preferences, challenges, and facilitators. Pharmacists emphasized a need for standardized, competency-based, and practice-oriented MTM training. They strongly preferred content that aligned with daily practice and focused on prevalent chronic diseases. However, they also identified several contextual challenges that might influence implementation, including geographical and cost barriers, limited digital access, and competing responsibilities. Institutional and policy support, as well as post-training mechanisms, were considered factors that may facilitate learning sustainability and implementation in routine care. Pharmacists in Indonesian PHCs perceive clear needs, preferences, challenges, and facilitators for MTM training. These findings can inform the development of context-sensitive, competency-based training programs. Embedding such training into continuing professional development frameworks is recommended to strengthen its sustainability and long-term impact, contributing to health professions education for primary care pharmacists.
The gut microbiota plays a crucial function in reproductive well-being and is vital for maintaining fundamental physiological balance. This article surveys the mutual relationships between the gut flora and the female reproductive system, which are maintained through metabolic, immunological, and neuroendocrine mechanisms, thereby creating the gastrointestinal-reproductive axis. Dysbiosis, which results from an imbalance in microbial levels, has been related with reproductive diseases, such as polycystic ovary syndrome (PCOS), infertility, endometriosis, and pregnancy-related problems. Modulation of the gut microbiota via targeted synthetic materials, such as metformin, dietary phytocompounds, synbiotics, probiotics, and prebiotics, affects hormonal levels, glucose resistance, and monthly cycle regulation, showcasing favorable prospects for medical care. This review elucidates the molecular and cellular processes underlying gut-reproductive relationships and assesses the potential of microbiome-targeted medications as viable clinical approaches for enhancing fertility outcomes. Further attention should be devoted to determining the crosstalk between endometrial disruption, hormonal imbalance, and inflammation.
Capsaicin, a natural bioactive alkaloid derived from chili peppers, has garnered increasing interest for its broad spectrum of pharmacological activities. Beyond its well-recognized analgesic, anti-inflammatory, and metabolic regulatory properties, accumulating evidence underscores its emerging roles in tumor suppression and immune modulation. Recent studies demonstrate that capsaicin profoundly influences the function and metabolism of diverse immune cell populations-including T cells, natural killer cells, macrophages, and dendritic cells-thereby enhancing antitumor immunity and immune surveillance. Building upon these findings, recent studies support combinatorial strategies that integrate capsaicin with conventional anticancer therapies to improve chemosensitivity and therapeutic efficacy. This review summarizes the latest advances in understanding how capsaicin regulates immunometabolism and remodels the tumor immune microenvironment, with an emphasis on the molecular mechanisms underlying its antitumor activity and potential implications for future therapeutic development.
Vancomycin therapeutic drug monitoring is essential for optimizing efficacy and reducing the risk of vancomycin-associated acute kidney injury (VA-AKI). Although recent guidelines recommend the ratio of area under the curve over 24 h to minimum inhibitory concentration (AUC24/MIC)-based monitoring over trough concentration-based monitoring, differences between AUC24/MIC estimation methods (e.g., pharmacokinetic equations and Bayesian approaches) may influence therapeutic classification in clinical practice. In addition, pharmacogenetic factors contributing to interindividual variability in vancomycin exposure remain incompletely characterized. This prospective, single-center cohort study included adult patients who received intravenous vancomycin for at least 72 h between June 2024 and April 2025. Vancomycin trough and peak plasma concentrations were measured using an enzyme-linked immunosorbent assay. AUC24/MIC values were calculated using pharmacokinetic equation and Bayesian method. Agreement in therapeutic classification between trough concentration-based and AUC24/MIC-based monitoring was assessed. Associations between the rs2789047 genetic variant and relevant parameters were also evaluated. Thirty-six patients were included, of whom 38.9% developed VA-AKI. Despite strong correlations between trough concentration and AUC24/MIC values (r = 0.84-0.87), substantial discordance in therapeutic classification was observed, with agreement rates of 63.9% for pharmacokinetic equation-based and 66.7% for Bayesian-based compared with trough concentration-based monitoring. In contrast, pharmacokinetic equation-based and Bayesian-based methods demonstrated strong concordance (86.1%). Higher trough concentrations and AUC24/MIC values were significantly associated with VA-AKI (p < 0.001). Carriers of rs2789047 A-allele exhibited higher trough concentrations and reduced elimination rates. Trough concentration-based monitoring frequently misclassified vancomycin exposure compared with AUC24/MIC-based approaches. Pharmacogenetic variability may further influence vancomycin exposure.
We previously identified patient need for a decision aid on oral corticosteroid (OCS) use during pregnancy that could be used to support discussions between providers and patients. In the current study, we aimed to identify healthcare provider needs for a decision aid on OCS use during pregnancy and then evaluated the usefulness of the decision aid that we developed. Before developing a decision aid on OCS use during pregnancy, we conducted semi-structured interviews with providers from one health system to understand needs for an aid for counseling patients about OCS use during pregnancy. To assess the usefulness of the decision aid that we developed, providers reviewed the decision aid and responded to survey questions. Also, the survey assessed provider knowledge regarding counseling on OCS use during pregnancy before and after reviewing the aid (knowledge scores range 0-15). In interviews, all providers (n = 13) reported that a patient-facing decision aid would be useful when discussing OCS use during pregnancy because it would give information to patients and providers, and it would facilitate decision making. Among the providers who participated in the survey (n = 68), two-thirds reported after reviewing the aid that they would usually or always use the decision aid in conversations about OCS treatment during pregnancy. All survey participants reported that they would recommend the decision aid to colleagues. Overall, providers' median knowledge score improved by 1 (IQ range 3) after reviewing the decision aid (p < 0.01). We established the usefulness of a decision aid on OCS use during pregnancy for providers. We developed and evaluated a decision aid about oral corticosteroid (OCS) use during pregnancy. First, we interviewed 13 healthcare providers to understand their needs for a decision aid that can be used to counsel patients about OCS use during pregnancy. After we developed the aid, 68 providers reviewed the aid and participated in a survey to assess the usefulness of the aid. All interviewed providers believed that a patient‐facing decision aid would be useful when discussing OCS use during pregnancy with patients. They believed it would give information to the patient and the provider, and it would increase discussion and help patients make decisions. Two‐thirds of survey participants reported that they would usually or always use the decision aid to have a conversation about OCS use during pregnancy. All survey participants reported that they would recommend the decision aid to colleagues. Overall, provider knowledge of counseling on OCS use during pregnancy improved after reading the aid.
Hirudo (HO) is the medicinal name for the dried whole body of leeches, including species such as Whitmania pigra Whitman, Hirudo nipponica Whitman, and Whitmania acranulata Whitman, all of which belong to the family Hirudidae. It is characterized by a salty, bitter taste and a neutral nature with mild toxicity. HO is traditionally used to activate blood circulation, regulate menstruation, and eliminate blood stasis, making it effective in treating conditions like blood stagnation with menstrual irregularities, abdominal masses, stroke sequelae, and traumatic injuries. This review aims to provide a comprehensive overview of HO from the perspectives of its zoological characteristics, traditional applications, processing methods, chemical composition, pharmacological activities, quality control, and toxicity. The goal is to offer a reference for the rational use of HO and to lay the foundation for related clinical research. This review searched the literature on HO in databases including ResearchGate, Web of Science, Baidu Scholar, Google Scholar, CNKI, and other databases using the keywords HO, zoology, compounds, pharmacology, and quality control. More than 140 chemical constituents have been identified in HO., including 65 types of peptides (1-65), 8 types of pteridines (66-73), 34 types of lipids (74-107), 17 types of amino acids (108-124), and 18 other chemical compounds (125-142). Among these, peptides are the main active ingredients of HO, exhibiting pharmacological effects such as anticoagulation, antithrombosis, anti-atherosclerosis, anti-tumor, anti-inflammatory, and anti-fibrotic activities. Notably, HO has shown significant efficacy in anticoagulation and antithrombosis. It can treat cardiovascular diseases through mechanisms such as inhibiting blood coagulation, preventing platelet aggregation, and promoting fibrinolysis. While HO demonstrates remarkable pharmacological activities, its distinct fishy odor may affect patient compliance, requiring further processing to eliminate this unpleasant scent. This review also systematically outlines the quality control standards, toxicity, and clinical applications of HO. This review systematically summarizes the zoological characteristics, traditional uses, processing methods, chemical composition, pharmacological activity, quality control, and toxicity of HO. Current research indicates that peptides are the primary bioactive components responsible for HO's anticoagulant, antithrombotic, anti-inflammatory, and anti-fibrotic activities, particularly in the treatment of cardiovascular diseases. This review also emphasizes the importance of establishing a robust quality control system and further elucidating the pharmacological mechanisms of HO to support its safe and rational clinical application.