Search Results (1,339)

Objectives: Long-term or inappropriate use of benzodiazepine receptor agonists (BZRAs) in older adults is a medication-safety concern. This study mapped trends, contributors, knowledge structures, and research hotspots of BZRA deprescribing using a comparative dual-database bibliometric framework. Methods: English-language articles and reviews from 1 January 2008 to 21 May 2026 were retrieved from the Web of Science Core Collection (WoSCC) and Scopus. Of the 377 WoSCC and 558 Scopus records entering topical relevance screening, 306 and 418, respectively, met the final eligibility criteria. Among the final datasets, 225 publications were shared, yielding 499 unique publications. The BIBLIO framework guided reporting. Analyses used R, bibliometrix, and VOSviewer, whereas CiteSpace-based analyses were restricted to WoSCC. Data for 2026 were partial; trend models used complete years through 2025. Results: Publication output showed an overall upward trend, with output during 2021–2025 generally higher than in earlier years. Quadratic models based on 2008–2025 data showed good fit for WoSCC (R² = 0.8890) and Scopus (R² = 0.9104). The United States, Canada, and Australia were leading contributors, and the University of Montreal was the leading institution (WoSCC, n = 19; Scopus, n = 18). Across both databases, themes evolved from withdrawal, discontinuation, and potentially inappropriate prescribing toward medication safety, prescription optimization, medication review, patient education, and implementation in primary care and long-term care settings. Conclusions: BZRA deprescribing research has broadened from drug discontinuation toward a patient-centered medication-safety and prescription-optimization framework. Future research should evaluate individualized tapering, nonpharmacological support, multidisciplinary care models, and standardized long-term patient-centered and safety outcomes. Full article

POI and EOI are rare but impactful conditions among adolescents and young adults (AYAs). Little is known about the timing and incidence of mental health (MH) conditions among AYAs diagnosed with POI/EOI. Data were collected using MarketScan Medicaid administrative claims among females aged 12–25 with POI/EOI. Merative™ MarketScan^® Research Databases are large, de-identified U.S. administrative healthcare claims databases that contain individual-level information on enrollment, inpatient and outpatient medical services, and outpatient prescription drug claims. The databases include commercially insured individuals, Medicare beneficiaries with employer-sponsored supplemental coverage, and selected Medicaid populations. Claims are linked longitudinally using unique encrypted patient identifiers, allowing individuals to be followed over time across healthcare settings. In addition to healthcare utilization, the databases include demographic characteristics, diagnosis and procedure codes, dates of service, and payment information, making them well suited for epidemiologic, health services, and outcomes research. We characterized prevalence and timing of MH diagnoses, examined MH subtypes, and estimated new-onset MH among those without prior MH. Comparisons were made to demographically matched controls without POI/EOI (matched on age and calendar time) and to diagnosis-anchored comparator groups. Among 859 AYAs with POI/EOI, 53.9% had any MH diagnosis, including 32.9% with MH diagnoses before and after POI/EOI diagnosis and 11.9% with new-onset MH after POI/EOI diagnosis. Of all anxiety disorders, 60.1% were present pre- and post-diagnosis, while 25.4% were new-onset after diagnosis. Depressive disorders showed a similar pattern, with 58.1% being pre- and post-diagnosis MH group and 22.3% being new-onset. In total, 49.4% of individuals with trauma-related disorders had the diagnosis both before and after POI/EOI diagnosis, while 30.1% had it as a new-onset. In adjusted models, POI/EOI was associated with increased odds of MH diagnoses after diagnosis (aOR ~2.1, 95% CI ~1.4–3.1). Prior MH diagnoses were the strongest predictor of MH after diagnosis (aOR ~12.1). AYAs with POI/EOI experience substantial MH burden, with elevated risk of new-onset MH conditions following diagnosis. Findings highlight the importance of early MH screening and integrated care models for AYAs. Full article

The Japanese label specifies suvorexant 20 mg once nightly for adults and 15 mg once nightly for older adults, but dose selection has not been characterized across all doses. We conducted a single-center retrospective drug-utilization study of outpatient prescriptions and inpatient medication orders at a Japanese university hospital during 2023–2025. Dose and prescription-date age were reconstructed, and patient-cluster bootstrap confidence intervals addressed repeated prescriptions. Among 3755 records, 15 mg accounted for 68.4%, 20 mg for 29.9%, and 10 mg and other calculable doses each for 0.9%. Of 3685 age-classifiable 15/20 mg records, 2529 were concordant with the operational age-based framework (68.6%; 95% CI 62.5–74.2). Non-concordance predominantly comprised 15 mg in patients younger than 65 years (841/1646; 51.1%); 20 mg in patients aged 65 years or older occurred in 315/2039 records (15.4%). Concordance was 65.0% in outpatient and 73.8% in inpatient records. Full-dose retention revealed uncommon 7.5- and 30-mg selections that a binary analysis would omit. Together, these findings provide a descriptive, single-center, full-dose, age- and setting-stratified basis for medication-use evaluation and targeted contextual review. Full article

Background/Objectives: Patient access to cannabinoid-based therapies in Brazil has expanded with the availability of regulated Cannabis-derived products (CDPs). This study explored CDP prescribing practices among Brazilian physicians. Methods: Between September 2024 and March 2025, a national online survey assessed physician characteristics, prescribing status, and reasons for non-prescription. Among prescribers, we analyzed CDP formulations, brands, indications, patient age groups, and time to therapeutic response. Bivariate and multivariable analyses identified factors associated with CDP prescribing. Results: A total of 333 physicians participated in the study, including 305 prescribers and 28 non-prescribers. Most CDP prescribers worked in private practice settings (67.9%). Specific training in CDP prescribing was the factor most strongly associated with a higher likelihood of prescribing (adjusted OR, 100.73; 95% CI, 12.77–794.72; p < 0.001), while lack of knowledge was the main reason for non-prescription. Although some physicians reported prescribing national products, imported products remained predominant (75.8% vs. 24.2%). Products provided through patient associations were also frequently mentioned. Predominant indications included mental and behavioral disorders, neurological diseases, and pain. Oil-based cannabidiol (CBD) formulations were the most frequently prescribed and were generally administered orally or sublingually. Older patients were the most frequently reported recipients of CDP prescriptions, and most physicians reported observing therapeutic effects within 30 days. Conclusions: Despite an evolving regulatory framework, clinical practice remains challenged by gaps in clinical training and disparities in patient access. Full article

Feline infectious peritonitis (FIP) is responsive to treatment with the adenosine analogue GS-441524 (GS-44) and its prodrug, remdesivir (REM); both are now available on veterinary prescription in many countries. Therapeutic drug monitoring (TDM) of GS-44 has the potential to support dose selection for individual cats; however, TDM assays are currently only offered by one UK-based laboratory. This study describes a simple, cost-effective, and environmentally conscious high-performance liquid chromatography (HPLC) method for the quantification of GS-44 in feline plasma or serum. The method was validated in accordance with the International Council for Harmonisation M10 guidelines for bioanalytical methods. Calibration standards demonstrated linearity across a range of 2.59 to 5048.28 ng/mL, R² = 0.9880, with a lower limit of quantification of 2.59 ng/mL and upper limit of quantification of 5048 ng/mL; this is equivalent to an assay range of 0.06 to 208 µM. Precision, accuracy and spike recovery were within ±15% for 14 of 17 standard concentrations (±20% at the lowest three). Carry-over, dilution integrity, and analyte stability under common storage conditions all met the method’s requirements. This is a simple, robust and accurate eco-friendly method suitable for adoption by diagnostic laboratories, enabling routine TDM for cats undergoing treatment for FIP with GS-44 and/or REM. Full article

Background/Objective: One of the missions of the United States FDA is “protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products.” The current guidelines for OTC hearing aids impose an output limit of 111 dB SPL for linear hearing aids and 117 dB SPL for compression hearing aids when measured using 90 dB SPL pure tones in a 2 cc coupler. This means that the sound pressure level at the ear drum at a frequency would be 111 or 117 dB SPL plus the real-ear-to-coupler difference (RECD) of the 2 cc coupler at the frequency. Methods: The maximum aidable hearing thresholds by hypothetical OTC-compression hearing aids that are compliant with the current FDA guidelines were explored using NAL-NL2 and DSLv5 prescriptive methods. The theoretical maximum permissible overall output levels in the ear canal were also calculated. Additionally, the fitting range of OTC-compression hearing aids with a maximum of 117 dB SPL output level at the ear drum was explored. Results: The current FDA guidelines allow OTC-compression hearing aids to provide sufficient gain and headroom to fit individuals with severe to profound hearing loss. In the presence of a loud wideband signal, the maximum overall output level can reach 164.5 dB SPL in the ear canal for an OTC-compression hearing aid with a bandwidth of 5657 Hz. When the maximum output levels are defined at the ear drum (i.e., the RECD is already considered), however, the fitting range is lowered to moderate hearing loss and the maximum overall output level is lowered by 10 dB. Conclusions: These findings identified potential regulatory vulnerability in the current FDA guidelines and suggest the need to take the measurement coupler and its corresponding RECDs into account when setting the guidelines for OTC hearing aids. Other alternative strategies to prevent potential abuses of the guidelines are also discussed. Full article

We seek to identify the most relevant benefits offered by Medicare Advantage Health Plans that are attractive to members and that drive membership and market share. We explore plans operating in a single county in New Jersey between 2018 and 2023. A dataset of benefits from publicly available data sources was created and the variance inflation factor was applied to identify the correlation between the extracted features, avoiding multicollinearity and overparameterization problems. We categorized the variable market share and used it as a multinomial response variable with three categories: less than 0.3%, 0.3% to 1.5%, and over 1.5%. Categories were chosen to achieve approximately uniform distribution of plans (47, 60 and 65, respectively). A multinomial Lasso model using 5-fold cross validation tunes the penalty parameter and reduces overfitting by dropping some features from the model, thus increasing interpretability. For each category, important variables vary. Certain brands drive market share, as do PPO plans and prescription drug coverage. Benefits, particularly ancillary benefits that are not part of CMS’s required benefits, appear to have little influence, while financial terms such as deductibles, copays and out-of-pocket limits are associated with higher market share. Finally, we evaluated the multinomial Lasso model on a held-out test set. The model achieved an overall classification accuracy of 0.76, meaning that 76% of plans were correctly classified into the low, medium or high market share categories. Full article

Food–medication interactions can occur when medicines are taken with foods, drinks, herbs, or supplements that influence drug absorption, exposure, or activity. Screening these combinations is challenging because the available evidence is imbalanced, prescription text may be recognized incorrectly, unsupported inputs may produce unreliable predictions, and altered software artifacts may change the recommendation presented to the user. iMediFood-Shield addresses these concerns through an evidence-first edge-AI framework that combines structured diet–drug interaction evidence, prescription-assisted medication confirmation, coverage-aware rejection, calibrated five-class prediction, false-safe-aware confidence gating, and software-based tamper-evident verification. The DDID preparation process began with 23,950 evidence records and produced 16,644 canonical medication–food/herb pairs, including 16,165 single-effect model-eligible pairs and 479 multi-effect conflict pairs. A leakage-free 70%–15%–15% split was applied after canonicalization, and the deployed lookup was restricted to training-supported and conflict records. On the operational locked-test AI branch of 2259 supported unseen pairs, the final calibrated LinearSVC with the validation-selected MedSafe-GATE threshold of 0.65 achieved 91.72% accuracy, 80.57% balanced accuracy, and a macro F1-score of 0.8359. The gate reduced calibrated false-safe predictions from 55 to 28, corresponding to a 49.09% reduction and a final false-safe rate of 1.35% among interaction-bearing AI-branch pairs. RxOCR-Guard achieved 94.67% candidate recall and 100.00% candidate precision on a controlled synthetic prescription benchmark, while mandatory user confirmation was retained because top-1 candidate accuracy was 51.33%. The unchanged baseline and all ten adverse software-bundle conditions produced the expected verification outcomes for artifact-modification, missing-file, key-mismatch, manifest-alteration, and rollback cases. Raspberry Pi deployment reproduced all 2259 reference predictions without mismatch, completed covered AI inference in 1.737 ms on average, and verified the protected software bundle in 80.249 ms on average. These results show that iMediFood-Shield can combine evidence-grounded screening, conservative AI decision control, prescription confirmation, and software-integrity verification within a resource-constrained edge research prototype. Full article

Background: Emergency department (ED) use for cancer-related pain is common, particularly among patients with metastatic disease who frequently require opioid analgesia. In October 2014, the U.S. Drug Enforcement Administration rescheduled hydrocodone combination products from Schedule III to Schedule II, introducing stricter prescribing and dispensing requirements. We evaluated whether hydrocodone rescheduling was associated with pain-related ED visits and hospitalizations among older adults with metastatic lung cancer. Methods: We conducted a retrospective SEER–Medicare cohort study of beneficiaries aged 66 years or older diagnosed with metastatic lung cancer. Diagnoses from January 2011 through September 2014 were classified as pre-policy, October 2014 was excluded as a transition month, and November 2014 through December 2018 constituted the post-policy period. Monthly 365-day cumulative incidences were estimated using the Aalen–Johansen estimator with death treated as a competing event. Segmented interrupted time-series models estimated immediate level and slope changes. Adjusted cause-specific Cox models evaluated time to first event. Results: The cohort included 52,371 beneficiaries. For narrowly defined neoplasm-related pain ED visits, the policy was associated with an immediate increase of 0.834 percentage points (95% CI, 0.330–1.338) and a post-policy slope increase of 0.030 percentage points per month (95% CI, 0.011–0.049). Pain-related hospitalizations increased immediately by 0.946 percentage points (95% CI, 0.336–1.556), with a slope increase of 0.024 percentage points per month (95% CI, 0.005–0.042). At 12 months, fitted cumulative incidences exceeded no-policy projections by 1.193 percentage points for ED visits and 1.228 percentage points for hospitalizations. Adjusted cause-specific hazard ratios were 1.14 for pain-related ED visits (95% CI, 1.00–1.30; p = 0.054) and 1.14 for hospitalizations (95% CI, 1.00–1.29; p = 0.049). Conclusions: Hydrocodone rescheduling was temporally associated with modest increases in acute-care encounters explicitly coded for neoplasm-related pain. The findings underscore the importance of preserving timely analgesic access for patients with advanced cancer. Full article

Background: Berberine, an isoquinoline alkaloid present in Berberis spp., Coptis chinensis and Hydrastis canadensis, is among the most widely consumed metabolic-health supplements, popularized as “nature’s Ozempic”. Concurrent, often undisclosed use with prescription drugs is common in older adults, yet berberine is far from inert. Objective: To synthesize the evidence on berberine as a perpetrator of supplement–drug interactions, propose a four-axis mechanistic taxonomy, with product quality treated separately as a modifier of exposure rather than as a mechanism, and derive a clinically actionable risk-stratification framework. Methods: Structured narrative review, prepared per the SANRA quality criteria; PubMed/MEDLINE, Scopus, Web of Science and Embase were searched up to May 2026. Results: Despite very low systemic exposure (oral bioavailability 0.68% in rats; low ng/mL plasma concentrations in humans), high luminal, enterocytic and hepatic concentrations generate interaction liability, documented in humans for a few pairs and mechanistic for most, along four mechanistic axes: inhibition, and transcriptional induction, of CYP3A4, with CYP2D6/CYP2C9 inhibition that is quasi-irreversible through a metabolite-intermediate complex; transporter modulation (P-glycoprotein, OCT1/OCT2, and MATE1); pharmacodynamic additivity (hypoglycemia, hypotension, and QT prolongation); and microbiome- and gut-barrier-mediated effects, the last of these being a candidate axis rather than a demonstrated one. Product-quality variability is treated separately, as a modifier of exposure. The clinical anchor is increased cyclosporine exposure in renal-transplant recipients (AUC +34.5%; trough 29.3% above control). These elements are integrated into a three-tier risk-stratification framework that combines perpetrator potency, victim-drug vulnerability, and patient vulnerability, with each tier being linked to a defined pharmacy action. Conclusions: In patients on multiple medications, and particularly when berberine is co-administered with drugs of narrow therapeutic index, it should be managed as an active pharmacological perpetrator rather than as an inert supplement. Unstandardized product quality and an unsettled European regulatory framework, under which national limits differ by more than an order of magnitude, further widen the uncertainty around the dose actually delivered. Berberine use should therefore be elicited routinely at medication reconciliation and stratified by mechanism, by victim-drug vulnerability, and by patient risk, with particular attention to metabolic self-medication in the GLP-1 era. Full article

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for pain, inflammation, and fever. Although many NSAIDs are available without a prescription, inappropriate use may increase the risk of renal, gastrointestinal, and cardiovascular complications. This study evaluated NSAID dispensing patterns and potential risk practices in community pharmacies in the Eastern Province of Saudi Arabia. Methods: A cross-sectional study was conducted in 90 community pharmacies across Al-Ahsa, Al-Dammam, and Jubail Industrial City between February and March 2025. Data on demographics, NSAID type, indication, dosage, frequency, duration, and concomitant medication use were collected and analyzed descriptively. Results: Among the 171 documented NSAID dispensing cases, 98 (57.3%) occurred without a prescription, whereas 73 (42.7%) involved prescription-based dispensing. Ibuprofen (62%) and diclofenac (36.3%) were the most commonly dispensed agents, with oral tablets being the preferred formulation (76.6%). Most documented treatment durations were short (3–7 days) with once- or twice-daily dosing. Common documented indications included dental conditions, pain, and inflammation, although the indication was not specified in 57.3% of cases. At least one potential interaction was identified in 11(7.8%, 95% CI 4.4–13.4%) of the 141 cases with concomitant medication use, corresponding to 13 (5.9%, 95% CI 3.5–9.9%) potential interaction pairs. Conclusions: Frequent non-prescription NSAID dispensing, incomplete documentation, and potentially clinically relevant drug interactions highlight the need to strengthen medication review, documentation, public awareness, regulatory oversight, and pharmacist counseling in community pharmacy practice. Full article

Polycystic ovary syndrome (PCOS) is a common hormonal disorder in women of reproductive age and is characterized by ovarian hyperandrogenism and irregular ovulation. This often leads to infertility. Beyond reproduction, PCOS causes widespread metabolic issues such as insulin resistance (IR), increasing long-term risks for diabetes, obesity, and heart disease. In a vicious cycle, IR acts as a core driver of both clinical symptoms and associated obesity, whereas compensatory hyperinsulinemia stimulates ovarian androgen production, causing ovulatory dysfunction and worsening weight gain, with immune imbalances exacerbating systemic chronic low-grade inflammation (CLGI). Berberine is a natural plant alkaloid that, owing to its multifaceted metabolic effects—including activation of 5′ adenosine monophosphate (AMP)-activated protein kinase (AMPK) and improvement of insulin sensitivity—effectively supports the restoration of homeostasis in women with PCOS. The aim of this narrative review is to comprehensively analyze the metabolic and anti-inflammatory actions of berberine, which, in combination with the known pathomechanisms of PCOS, may constitute a rationale for its therapeutic application. Attention was given to the necessity of actions aimed at increasing the bioavailability of berberine and to the consequences of the fact that berberine, unlike metformin, which is commonly used and has similar properties, is a dietary supplement and not a Food and Drug Administration (FDA)-approved prescription drug. Full article

Background/Objectives: Medication safety is a critical concern in older adults due to age-related vulnerability, multimorbidity, and polypharmacy. Pro Re Nata (PRN, “as needed”) prescribing is common in geriatric care but may be interpreted inconsistently across healthcare professionals, potentially increasing the risk of medication errors. This study aimed to evaluate PRN prescribing patterns in hospitalized older adults and assess interprofessional perceptions of the clarity and appropriateness of PRN prescribing for conditions. Methods: We conducted a prospective, single-day observational study in a French geriatric university hospital, including all patients aged ≥65 years with at least one medication prescription. PRN prescriptions were extracted from electronic medical records and independently assessed by a pharmacist, nurse, and physician for clarity and appropriateness. Descriptive statistics summarized PRN use, chi-square tests assessed interprofessional differences, and multivariate logistic regression identified predictors of appropriate PRN wording. Results: Among 316 patients, 1035 PRN prescriptions were analyzed, representing 24.5% of all medication entries. Only 51.3% (n = 531) were deemed appropriate by all evaluators. Significant differences in interpretation were observed across professional groups (p < 0.001 for most pairwise comparisons). PRN prescriptions were most frequent in long-term care units and primarily involved gastrointestinal agents, analgesics, and psychotropic medications. Multivariate analysis showed that hospitalization in long-term care (OR = 4.17; 95% CI 2.48–7.03) or rehabilitation units (OR = 2.07; 95% CI 1.22–3.53) with a higher number of prescriptions administered under a therapeutic protocol PRN (OR = 2.27; 95% CI 1.39–3.63) were independently associated with appropriate wording, while a higher total number of PRN prescriptions reduced appropriateness (OR = 0.87; 95% CI 0.82–0.94). Conclusions: PRN prescribing is frequent in hospitalized older adults and often involves high-risk or potentially inappropriate medications. Substantial interprofessional variability in the interpretation of PRN medication wording requires appropriate, standardized, and clinical PRN guidelines to improve medication safety and reduce potential adverse events in geriatric practice. Full article

Background/Objectives: We describe how our in-house bioinformatics platform, Flype, has evolved from being a variant repository to an enterprise role as an electronic medical record (EMR) content provider, powering molecular pathology reporting, pharmacogenomics reporting, sending discrete data to our EMR, aggregating internal and external molecular test results and powering our molecular tumor board (MTB). Methods: In response to critical pain points, we developed Docket, a sample tracking system in Flype, which manages multiple individual in-house molecular tests for NGS assays, pharmacogenomic (PGX) assays and additional molecular testing. To help with interpretation and integration of all internal and external assays, we developed a clinical outcomes view in Flype. To improve the efficiency of our molecular pathologists reporting results, we developed Convo 2.0, which integrates OncoKB interpretations and other information. Flype can also be used by our pathologists to submit patient molecular results to NCI’s ComboMATCH and retrieve clinical trial recommendations. Results: Flype was used during our Kellogg Cancer Genomic Initiative for reporting PGX integration, MTB review and integration of EMR prescription information with internal and external molecular test results. Integrating PGX results led to several recommendations against the use of drugs metabolized by, for example, CYP2D6 or TPMT, along with warnings about altered pain relief. Enhancements in report sign-out and the use of file transfer scripts have led to reduced turnaround time. Conclusions: Flype supports hundreds of users performing different roles in molecular diagnostics. We discuss lessons learned adapting our software to support continuously changing test requirements. Full article

“Triple whammy” prescriptions, combining non-steroidal anti-inflammatory drugs (NSAIDs), renin–angiotensin system (RAS) inhibitors, and diuretics, increase acute kidney injury (AKI) risk. To clarify the frequency and profiles of these prescriptions and identify vulnerable populations, we analyzed the AHI partners database to estimate the number of individuals prescribed these three drug classes. In the single-agent analysis, loxoprofen was the most commonly prescribed NSAID (66.3%), olmesartan (19.4%) and telmisartan (15.9%) were the predominant RAS inhibitors, and furosemide (19.6%) and spironolactone (16.0%) were the most frequently used diuretics. Dual-drug combinations showed patterns consistent with the single-agent results for NSAIDs and diuretics. By contrast, sacubitril/valsartan was the most common RAS inhibitor when combined with diuretics, frequently utilized for heart failure management. In triple whammy prescriptions, NSAIDs and diuretics patterns mirrored those of single-agents. The annual number of triple whammy prescriptions showed a statistically significant downward trend over the study period by the Mann–Kendall trend test (p = 0.048). Notably, sacubitril/valsartan was the leading RAS inhibitor (46/199 patients, 23%), showing a higher proportion than its single-agent use (7.4%). Heart failure patients prescribed these two causative drugs are highly vulnerable to “triple whammy” prescriptions. Awareness of inadvertent NSAID additions is warranted to mitigate potential AKI risks. Full article