Search Results (233)

Certain medications may adversely affect health during hot days and heatwaves by altering chronic conditions, comorbidities, fluid balance, or impairing heat adaptation. This study aims to develop evidence-based cross-sectoral recommendations for the safe administration of heat-sensitive medications, compiled into a so-called ‘CALOR’ list (calor: Latin for ‘heat’). Development of the CALOR list will follow a four-pillar process. First, a scoping review of scientific literature and best practices will identify potentially inadequate medications during heat events (heat-PIMs) and adaptation measures, resulting in a first draft. Second, an expert panel will refine this draft through a Delphi process to reach consensus on clinically relevant recommendations. Third, German statutory health insurance (SHI) claims data will be analysed to determine heat-PIMs prevalence; data from Cologne residents will additionally be linked with climate data to investigate health outcomes during heat events. Fourth, thirty health professionals (i.e., medical doctors, nurses, pharmacists) will field-test the CALOR list in summer, providing qualitative feedback on feasibility, leading to further refinement of the CALOR list. To our knowledge this study protocol presents the first study attempting to collate a comprehensive and actionable list of recommendations for drug safety management during hot days and heatwaves. Full article

Background/Objectives: The accumulation of unused and expired pharmaceuticals in households is a growing public health concern with implications for patient safety, rational drug use, and environmental health. However, systematic risk characterization integrating clinical and environmental perspectives at the community level remains limited, particularly in low- and middle-income settings. This study aimed to develop and apply a composite risk index, grounded in an eco-pharmacovigilance framework, for the assessment of health risks associated with accumulated household pharmaceuticals in southeastern Mexico. Methods: A cross-sectional study was conducted in 526 randomly selected households using stratified sampling. Guided in-home medication inventories were performed with participant collaboration, and pharmaceuticals were classified according to the Anatomical Therapeutic Chemical (ATC) system. A composite risk index (CRI = Fr × PR) was developed within an eco-pharmacovigilance framework. The frequency of accumulation (Fr) for each therapeutic group was multiplied by a potential risk score (PR) derived through a structured multidisciplinary expert consensus process integrating clinical toxicity, environmental persistence, and antimicrobial resistance potential. Results: A total of 2184 pharmaceutical units were recorded during the household inventories, of which 28.7% were expired. Expired medications were primarily retained rather than actively used, representing a latent risk for inappropriate self-medication and accidental exposure. The therapeutic groups with the highest CRI values were antihypertensives (CRI = 42.3), antidiabetics (CRI = 37.8), and antibiotics (CRI = 31.5), indicating a relatively higher contribution within the composite risk index framework to overall household pharmaceutical risk. These findings highlight priority therapeutic groups driven by the combined effect of high accumulation frequency, distinct accumulation patterns, and intrinsic hazard. Conclusions: Household pharmaceutical accumulation can be characterized using a composite, eco-pharmacovigilance-based approach that integrates exposure and hazard dimensions. The proposed framework functions as a prioritization tool rather than a precise quantitative measure, enabling the identification of therapeutic groups requiring targeted intervention. Findings should be interpreted as indicative of relative risk patterns rather than precise estimates, given the exploratory design and guided data collection approach. The proposed framework provides a practical tool for prioritizing interventions aimed at improving rational drug use, reducing accumulation, and mitigating environmental impact. Further validation in diverse settings is warranted to strengthen its applicability. Full article

Older adults with type 2 diabetes mellitus (T2DM) are at high risk of polypharmacy and potentially inappropriate medication (PIM) use because of multimorbidity and complex treatment regimens. This systematic review and meta-analysis (PRISMA 2020; PROSPERO CRD420251149348) aimed to estimate the prevalence of polypharmacy and PIM use, describe PIM burden and patterns, and summarize the co-occurrence of PIMs among those with polypharmacy. On 7 September 2025, we searched PubMed, Scopus, Embase, Web of Science, and MEDLINE using a structured search strategy based on the PICO framework. Observational studies of older adults (≥65 years) with T2DM reporting polypharmacy and PIMs were included. Risk of bias was assessed using the JBI checklist, and prevalence estimates were synthesized using a random-effects meta-analysis. Five studies (13,350 participants) were included. Polypharmacy prevalence ranged from 43.6% to 95.3%, while PIM prevalence ranged from 23.4% to 74%. The co-occurrence of PIMs among polypharmacy users ranged from 39.6% to 74%. Commonly reported PIM classes included long-acting sulfonylureas, proton pump inhibitors, and benzodiazepines. Overall, polypharmacy and PIM use were frequently reported among older adults with T2DM; however, the wide variation in prevalence across studies indicates substantial clinical and methodological heterogeneity. These findings highlight the need for structured medication review and clinical context-based medication optimization beyond numerical thresholds. Full article

Objectives: Inappropriate medication use is highly prevalent in nursing home residents and contributes to adverse drug events, falls, and increased healthcare utilization. The Turkish Inappropriate Medication use in oldEr adults (TIME) criteria provide a comprehensive framework for identifying both potentially inappropriate medications and prescribing omissions. We aimed to evaluate the outcomes of a Medication Therapy Management (MTM) intervention by use of TIME criteria among nursing home residents in Türkiye. Methods: This single-arm before–after observational study included 232 adults aged 60–110 years residing in the Bursa Metropolitan Municipality Nursing Home. Medication use patterns were evaluated using the TIME criteria and prescriptions were optimized through a Medication Therapy Management (MTM) intervention. Fall frequency and healthcare utilization outcomes were recorded during the 1 year before and after MTM implementation. Results: Following implementation of the Medication Therapy Management (MTM) approach based on TIME criteria, the median number of medications increased from 5 (IQR: 3–8) to 8 (IQR: 5–10) over one year (p < 0.001). During the post-implementation period, fall frequency, emergency department visits, family medicine visits, and non-geriatric specialist visits were lower compared with the pre-intervention year, whereas hospitalization rates did not significantly change. Conclusions: Among nursing home residents, the total number of medications was higher and fall frequency and selected healthcare utilization measures were lower during the year following implementation of MTM based on TIME criteria. These findings suggest that MTM-guided prescription optimization may be associated with changes in clinical and healthcare utilization outcomes; however, the absence of a control group precludes causal inference, and randomized controlled trials are required to confirm these associations. Full article

Background: Post-bariatric hypoglycemia (PBH) is a clinically significant complication of bariatric surgery, characterized by inappropriate postprandial hyperinsulinemia and recurrent hypoglycemia. Episodes are often frequent, severe, and medically refractory, substantially impacting quality of life and potentially causing compensatory carbohydrate intake that leads to weight regain. Methods: A 50-year-old male underwent Roux-en-Y gastric bypass (RYGB) in 2009. Symptomatic postprandial hypoglycemia emerged in the second postoperative year and progressively worsened to multiple severe daily episodes. The patient developed compensatory carbohydrate intake with subsequent weight regain. Following the failure of dietary interventions and pharmacologic therapy, he underwent conversion to single-anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S) in September 2022. Results: Following surgical conversion, the patient reported no clinically significant hypoglycemia during the follow-up period. Weight and obesity-related comorbidities improved. Gastrointestinal symptoms remained manageable, and micronutrient status was closely monitored. Conclusions: In selected patients with severe, medically refractory PBH following RYGB, conversion to an ileal-based procedure may be considered a viable therapeutic strategy. Prospective studies are needed to better define this hypothesis. Full article

Background: Metabolic syndrome is a disorder characterised by the concomitant presence of obesity, hyperglycaemia, hypertension, hyperlipidaemia, and insulin resistance. An increasing body of research indicates that chronic inflammation, accompanied by oxidative stress and angiogenesis, plays a key role in the pathogenesis of the metabolic syndrome. Spice herbs may exert a beneficial effect when consumed daily in generally accepted amounts (1–3 g), thus providing relatively small quantities of bioactive compounds with anti-inflammatory properties. Their potential arises from regular long-term use rather than from the amount of bioactive substances delivered in a single dose. Methods: In this narrative review, we analysed data from the international literature on the effects of spice herbs (coriander, sage, mint, basil, rosemary, oregano and thyme) consumption on inflammation associated with metabolic syndrome in women. Results: The available literature provides limited data on the impact of spice herbs in the context of anti-inflammatory effects. A total of 124 publications were analysed, including 72 original research studies (48 involving humans) and 52 review articles and meta-analyses. Among the research articles included in the review, only 20 addressed both inflammation and at least one of the seven selected herbs: five were human studies, six involved laboratory animals, and eight were conducted in vitro. Analysis of the results from human studies demonstrated anti-inflammatory effects (decreases in TNF-α, IL-1β, IL-6, TLR4, hs-CRP) at daily doses not exceeding 3 g of individual herbs or 6.6 g of an herbal mixture. The use of spice herbs as a nutritional strategy to prevent chronic inflammation is supported by a growing body of scientific evidence. It should be emphasised that these studies are concerned with dietary support and prevention rather than with treatments that substitute for standard medical therapy. Incorporating spice herbs into the daily diet may represent a simple and safe approach to increasing the intake of anti-inflammatory bioactive compounds. Conclusions: Future research should focus on the precise determination of optimal doses and combinations of spice herbs to maximise benefits while avoiding potential adverse effects resulting from excessive intake of certain compounds or inappropriate selection of spice herbs. Long-term studies conducted in larger populations of women with metabolic syndrome are required, as physiological differences, particularly those related to oestrogens, may result in sex-specific effects. This review provides up-to-date information for further basic and clinical research on herbal medicine in metabolic syndrome. Full article

Background and Objectives: Self-medication and inappropriate use of non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics are major public health concerns, particularly in settings with variable access to healthcare. Understanding patterns of medication use and renal risk perception can inform targeted interventions. This study examined NSAID and antibiotic use, self-medication behaviors, and renal risk awareness among Romanian primary care patients, with attention to urban–rural differences. Materials and Methods: A cross-sectional survey was conducted among 201 primary care patients (101 rural, 100 urban). Data on NSAID and antibiotic use, self-medication practices, sources of recommendation, and renal risk perception were collected using a study-specific questionnaire. Multivariable logistic regression was applied to identify predictors of frequent NSAID use, inappropriate antibiotic use, self-medication frequency, and high perceived renal risk. Results: NSAID use was nearly universal (95%), with frequent use strongly associated with non-professional recommendations. Antibiotic misuse was more common in rural participants and largely driven by informal acquisition. Self-medication patterns differed by residence: rural participants reported system- or access-related reasons and reliance on non-professional sources, while urban participants engaged in frequent, convenience-driven self-medication. Although most participants were aware of potential renal harm, this did not consistently lead to safer behaviors. Higher educational level and trust in healthcare professionals predicted increased perceived renal risk, whereas rural residence was associated with lower risk perception. Conclusions: Medication misuse is influenced more by recommendation sources, access barriers, and trusted information pathways than by knowledge alone. Interventions should focus on improving professional guidance, addressing informal recommendation networks, and tailoring strategies to urban–rural contexts. Full article

Preconception care is globally recognized as essential for optimizing pregnancy outcomes; however, in Japan, comprehensive data on medication-related potential exposure to pregnancy-contraindicated medications among women of reproductive age remain limited. We conducted a retrospective cross-sectional descriptive study using data from Japan’s National Database of Health Insurance Claims (fiscal year 2022) to assess the potential exposure to pregnancy-contraindicated medications among women of reproductive age. Outpatient prescriptions for oral medications dispensed to women aged 15–49 years were analyzed. In total, 270 medications classified as contraindicated during pregnancy were identified, of which 75 were also contraindicated for women planning pregnancy. Of these, 58 active ingredients were restricted in both phases. Notably, 212 medications were uniquely contraindicated during pregnancy, highlighting the broader contraindication profiles during fetal development than during the preconception period. Despite these contraindications, high prescription volumes were observed for medications such as loxoprofen sodium hydrate, sodium valproate, and metformin hydrochloride among women of reproductive age. These findings illustrate a high baseline utilization of pregnancy-contraindicated medications among women of reproductive age. As most women in this demographic are neither pregnant nor actively planning conception, these volumes primarily reflect standard care rather than inappropriate prescribing. In conclusion, pharmacists serve as an important supplementary safety net by routinely confirming pregnancy status to prevent inadvertent exposure. Full article

Background/Objectives: Inappropriate use of antibiotics contributes to the rise in antibiotic-resistant bacteria and can result in adverse drug effects for individuals. Informed discussions between patients and general practitioners (GPs) can help ensure that treatment decisions about antibiotic use align with the best health outcomes for individuals. Methods: We implemented a set of information resources designed to support clinical discussions and decision-making for patients with common infections in primary care. A suite of patient information sheets, which had been co-designed with primary care providers and consumers, were implemented in eight general practices in metropolitan Melbourne and regional Victoria, from August to November 2020. Results: Post-implementation evaluation, conducted through interviews with 15 primary care providers and 13 patients, revealed that the information sheets were simple, easy to use and generated discussion within consultations. GPs reported using the sheets to reinforce their decision-making during consultations with patients, reduce potential conflict, provide alternatives to antibiotic prescriptions, and offer patients a written summary of management recommendations. Patients found the sheets informative and that they made it easier to understand their diagnosis and to manage their conditions. Both GPs and patients agreed that the content was relevant and effectively enhanced patients’ knowledge of disease conditions, treatment options, and when to seek medical advice and were facilitators of meaningful conversations during consultations. Conclusion: These resources are acceptable in Australian primary care and publicly available for use by GPs, pharmacists and patients in Australia. Full article

Artificial Intelligence is advancing rapidly, raising critical concerns about the integrity of digital content, particularly in sensitive domains such as medical imaging. Recent AI techniques, such as Generative Adversarial Networks (GANs) and diffusion models, can generate highly realistic synthetic medical images, posing risks of misdiagnosis, inappropriate treatment, and other adverse outcomes. This paper presents a deep learning-based approach to distinguish between authentic and synthetic images of skin malignancies generated by DCGAN, Wasserstein GAN (WGAN), and Stable Diffusion. A comprehensive dataset was constructed using authentic malignant skin images from an open-source Kaggle repository, alongside artificially generated images. Multiple deep learning models were trained and evaluated, with DenseNet169 achieving the highest performance, reaching 99.67% training accuracy, 97.50% validation accuracy, and 98.50% test accuracy—along with substantial precision, recall, and F1 scores across all classes. These results demonstrate the model’s efficacy in identifying both real and fake medical images. This work contributes to the emerging field of medical image forensics, highlighting its potential integration into clinical and insurance workflows to prevent fraud, strengthen trust, and mitigate risks. Furthermore, it lays the groundwork for future studies involving larger datasets, additional Deepfake generation methods, and real-time clinical applications. Full article

Background/Objectives: This pilot study aimed to evaluate the feasibility of applying the Beers criteria in the community pharmacy setting and aid pharmacists in identifying and emphasizing adverse effects from potentially inappropriate medications (PIMs) for older adults. Methods: We applied a single-center retrospective study to collect demographic and outcome data in order to analyze dispensed PIMs for older adults. We used an evaluation tool to compare warnings between pharmacy dispensing software and the Beers criteria. Descriptive statistics were computed via standard statistical software. Results: Culled from a random selection of 215 patients, the medical records from 50 subjects ≥65 years old were reviewed, including 440 of their medications. Our data demonstrated that 96% of subjects were dispensed at least one PIM, with a total of 34 different PIMs distributed at varying frequencies. A comparative analysis indicated that 74% of dispensed medications had similar, but not identical, warning profiles presented in the dispensing software and Beers criteria. Anticholinergic burden of dispensed PIMs indicated that older adults were at risk of falls and delirium. By supplementing the dispensing software with Beers criteria, we were able to create clinical communication notes for providers, patients, and pharmacy students to emphasize the role pharmacists can play to minimize PIM’s adverse effects on older adults. Conclusions: Our data indicates the feasibility of implementing the Beers criteria in the community pharmacy setting. Integrating the dispensing software warnings with Beers criteria created a structured intervention strategy to prevent potential adverse effects and develop clinical communication notes to emphasize a more engaging role that the community pharmacy setting can play to optimize therapeutic outcomes for older adults. Full article

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used analgesics. However, their inappropriate or excessive use may lead to serious adverse effects. The aim of the study was to analyze behavioral patterns and attitudes toward the use of over-the-counter (OTC) NSAIDs, as well as the perception of risks associated with their use. Methods: A cross-sectional survey was conducted among 567 respondents. An anonymous questionnaire consisting of 26 items was used, addressing sociodemographic characteristics, frequency of reading drug information leaflets, frequency of NSAID use, and awareness of potential adverse effects associated with these medications. Results: The demographic factors significantly influenced NSAID-related behaviors. Women were significantly more likely than men to read drug information leaflets and reported more frequent use of OTC NSAIDs. Older respondents exhibited greater adherence to the principles of responsible NSAID use. Higher educational attainment was associated with more frequent and attentive reading of drug information leaflets. Urban residents reported higher median frequencies of NSAID use, whereas students demonstrated greater awareness of potential NSAID adverse effects compared with non-students. Conclusions: The results reveal complex patterns of NSAID consumption and underscore the need for implementing targeted public health interventions. 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

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

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