Diagnosis and treatment of stroke associated pneumonia: qualitative exploration of clinicians' practice

Background: Establishing and implementing a gold standard criteria for diagnosing and treating stroke-associated pneumonia (SAP) would have a significant positive impact on stroke outcomes and antibiotic stewardship. This study aimed to qualitatively explore current diagnostic and treatment practice for SAP among clinicians. Methods: A qualitative study was employed to conduct semi-structured interviews at the tertiary-care Jordan University Hospital. A purposive sampling technique was employed to recruit the participants, including respiratory consultants (n=3) and residents (n=9) practicing in the internal medicine wards and intensive care unit, where stroke patients are treated. The interviews were audio-recorded, transcribed verbatim, translated, and analyzed thematically using framework analysis. Results: Clinicians expressed their experiences, which were organized into two themes and eight emerged sub-themes: Terminology and diagnostic approach of SAP involved; no definite terminology, reliance on both clinical evidence and X-ray findings to decide, reliance on clinical evidence alone to suspect SAP and initiate empirical therapy, and SAP overdiagnosis. The treatment strategies include early treatment of SAP, treating SAP the same as CAP/HAP, predominant anaerobes coverage, and SAP overtreatment. Conclusion: Our findings show a wide range of physician-based diagnostic and treatment approaches for SAP, with clinical criteria serving as the main driver for antibiotic initiation. Standard validated algorithmic-based criteria need to be established and implemented

What works to support better access to mental health services (from primary care to inpatients) for minority groups to reduce inequalities? A rapid evidence summary

It is estimated that one in four people will experience poor mental health1 throughout their lifetimes. However, ethnic minority groups1, refugees and asylum seekers1 experience more barriers accessing mental health services and have poorer mental health outcomes than those from non-ethnic minority groups. Evidence suggests that interventions that improve access and engagement with mental health services may help reduce disparities affecting ethnic minority groups, refugees and asylum seekers. Thus, the aim of this rapid evidence summary was to explore the literature on what works to support better access to mental health services for ethnic minority groups, refugees and asylum seekers to reduce inequalities. The review included interventions that were developed or assessed to improve equity1 in access, engagement, utilisation, or provision of mental health services. Research Implications and Evidence Gaps: There is limited review evidence regarding the effectiveness of interventions to improve access to mental healthcare across ethnic minority groups. Review evidence regarding interventions to support refugees’ and asylum seekers’ access to primary healthcare or specialised clinics (for example pregnancy and postpartum) is available, but the findings related to mental health care cannot be extracted

A rapid review of physical health risks associated with special procedures (tattooing, body piercing, acupuncture, electrolysis)

Special procedures, such as tattooing (including semi-permanent make-up), body piercing, acupuncture and electrolysis involve piercing the skin and carry a potential risk of infection and other complications. This review provides an up-to-date evidence base on the main physical health risks associated with these special procedures. Searches were conducted for research published between 2015 and 2023. Where possible, existing reviews were used. For tattooing, one systematic review including 55 studies was identified. For semi-permanent make-up, 37 cases presented in 31 case reports were identified. For body piercing, four systematic reviews were identified, which covered 174 studies. For acupuncture, one evidence map of 535 systematic reviews without age limits and one overview of 24 systematic reviews focused on children were included. For electrolysis, one case report was identified. Complications and adverse events resulting from special procedures include fungal infections, bacterial infections, viral infections, blood-borne infections, allergic reactions, malignant growths, benign growths, sarcoidosis-related reactions, and a range of other skin and eye-related adverse reactions and dental issues. Research Implications and Evidence Gaps: Most of the primary evidence for the physical health risks associated with the special procedures came from case reports and case series, which do not allow causal inferences or provide information on the prevalence of adverse events. Future primary research should employ more robust designs to gather evidence about the causal links between special procedures and adverse physical health events as well as about the prevalence of such events in people receiving special procedures. More evidence is needed to identify physical health risks associated with electrolysis. Policy and Practice Implications: The evidence contained in this review will be used to inform the training of local authority enforcement officers and special procedures practitioners and to educate members of the public who seek to use these services. Due to the nature of the special procedures which involves piercing the skin and poses the risk of introducing infections to the body, high standards of hygiene may reduce the rate of infection

Prediction of low-dose aspirin-induced gastric toxicity using nuclear magnetic resonance spectroscopy-based pharmacometabolomics in rats

Background: Low-dose aspirin (LDA) is the backbone for secondary prevention of coronary artery disease, although limited by gastric toxicity. This study aimed to identify novel metabolites that could predict LDA-induced gastric toxicity using pharmacometabolomics. Methods: Pre-dosed urine samples were collected from male Sprague-Dawley rats. The rats were treated with either LDA (10 mg/kg) or 1% methylcellulose (10 mL/kg) per oral for 28 days. The rats’ stomachs were examined for gastric toxicity using a stereomicroscope. The urine samples were analyzed using a proton nuclear magnetic resonance spectroscopy. Metabolites were systematically identified by exploring established databases and multivariate analyses to determine the spectral pattern of metabolites related to LDA-induced gastric toxicity. Results: Treatment with LDA resulted in gastric toxicity in 20/32 rats (62.5%). The orthogonal projections to latent structures discriminant analysis (OPLS-DA) model displayed a goodness-of-fit (R2Y) value of 0.947, suggesting near-perfect reproducibility and a goodness-of-prediction (Q2Y) of −0.185 with perfect sensitivity, specificity and accuracy (100%). Furthermore, the area under the receiver operating characteristic (AUROC) displayed was 1. The final OPLS-DA model had an R2Y value of 0.726 and Q2Y of 0.142 with sensitivity (100%), specificity (95.0%) and accuracy (96.9%). Citrate, hippurate, methylamine, trimethylamine N-oxide and alpha-keto-glutarate were identified as the possible metabolites implicated in the LDA-induced gastric toxicity. Conclusion: The study identified metabolic signatures that correlated with the development of a low-dose Aspirin-induced gastric toxicity in rats. This pharmacometabolomic approach could further be validated to predict LDA-induced gastric toxicity in patients with coronary artery disease

Factors associated with acceptance of COVID-19 vaccine among University health sciences students in Northwest Nigeria

Students of the health sciences are the future frontliners to fight pandemics. The students’ participation in COVID-19 response varies across countries and are mostly for educational purposes. Understanding the determinants of COVID-19 vaccine acceptability is necessary for a successful vaccination program. This study aimed to investigate the factors associated with COVID-19 vaccine acceptance among health sciences students in Northwest Nigeria. The study was an online self-administered cross-sectional study involving a survey among students of health sciences in some selected universities in Northwest Nigeria. The survey collected pertinent data from the students, including socio-demographic characteristics, risk perception for COVID-19, and willingness to accept the COVID-19 vaccine. Multiple logistic regression was used to determine the predictors of COVID-19 vaccine acceptance. A total of 440 responses with a median (interquartile range) age of 23 (4.0) years were included in the study. The prevalence of COVID-19 vaccine acceptance was 40.0%. Factors that independently predict acceptance of the vaccine were age of 25 years and above (adjusted odds ratio, aOR, 2.72; 95% confidence interval, CI, 1.44–5.16; p = 0.002), instructions from heads of institutions (aOR, 11.71; 95% CI, 5.91–23.20; p<0.001), trust in the government (aOR, 20.52; 95% CI, 8.18–51.51; p<0.001) and willingness to pay for the vaccine (aOR, 7.92; 95% CI, 2.63–23.85; p<0.001). The prevalence of COVID-19 vaccine acceptance among students of health sciences was low. Older age, mandate by heads of the institution, trust in the government and readiness to pay for the vaccine were associated with acceptance of the vaccine. Therefore, stakeholders should prioritize strategies that would maximize the vaccination uptake

The role of genetic polymorphism and other factors on clopidogrel resistance (CR) in an Asian population with coronary heart disease (CHD)

Clopidogrel is a widely-used antiplatelet drug. It is important for the treatment and prevention of coronary heart disease. Clopidogrel can effectively reduce platelet activity and therefore reduce stent thrombosis. However, some patients still have ischemic events despite taking the clopidogrel due to the alteration in clopidogrel metabolism attributable to various genetic and non-genetic factors. This review aims to summarise the mechanisms and causes of clopidogrel resistance (CR) and potential strategies to overcome it. This review summarised the possible effects of genetic polymorphism on CR among the Asian population, especially CYP2C19 *2 / *3 / *17, where the prevalence rate among Asians was 23.00%, 4.61%, 15.18%, respectively. The review also studied the effects of other factors and appropriate strategies used to overcome CR. Generally, CR among the Asian population was estimated at 17.2–81.6%. Therefore, our overview provides valuable insight into the causes of RC. In conclusion, understanding the prevalence of drug metabolism-related genetic polymorphism, especially CYP2C19 alleles, will enhance clinical understanding of racial differences in drug reactions, contributing to the development of personalised medicine in Asia

What is the forecasted prevalence and incidence of long-term conditions in Wales: a rapid evidence map

It is becoming apparent that the NHS will face many issues in years to come due to the growth of ageing population in relation to the working age population alongside the increase in multimorbidity and persistent health inequalities, particularly for preventable illness. This has implications to how healthcare and health systems are delivered, and how the NHS will need to adapt to meet the increasing demand that this places on healthcare services. This rapid evidence map reports forecasted prevalence and incidence data across a range of long -term conditions in Wales to support planning about how best to organise and finance care for the increasing population with long-term conditions over the next 10 years. The findings by conditions include: atrial fibrillation, cancer, cardiovascular diseases, peripheral vascular disease, stroke, dementia, diabetes, heart failure, hypertension, mental illness, and multi-morbidities. Three risk factors for long term conditions were also included, i.e., poor diet/nutrition, obesity, and smoking. The review included evidence from 2012 to March 2023 Implications for policy and practice: Results show which long-term conditions are projected to increase over 10 years or more. Further preventive interventions through behavioural science approaches, with increased investment, should be considered to mitigate the rising prevalence of several preventable conditions. Smoking, excessive drinking and obesity are candidates for targeted preventive work, especially in areas of deprivation, to lessen health inequalities. Further research is needed for some conditions, and to provide a more comprehensive understanding of the burden of these conditions in Wales. Earlier diagnosis by genetic and genomic technologies and enabling lifestyle changes or by more cost-effective home care could reduce NHS costs of some long-term conditions

Unveiling the Peril of Substandard and Falsified Medicines to Public Health and Safety in Africa: Need for All-Out War to End the Menace

The peril of substandard and falsified medicines (SFM) risk complete failure of the United Nations Sustainable Development Goals on access to safe, effective, quality, and affordable essential medicines in African countries. The global market volume of SFM could be up to US$200 billion, and up to 70% of the total medicines in circulation could be SFM in some parts of Africa. This dominance in the region is a clear sign of SFM proliferation, which continues to cause avoidable health hazards leading to severe adverse effects and devastating loss of human lives, by compromising treatment of chronic, infectious, and life-threatening diseases, such as malaria, cancer, pneumonia, tuberculosis, and diabetes. Besides these consequences to public health and safety, the economic and societal detriments are also grave. Although the recent advancement in detection technology coupled with increased collaborative efforts among some African drug regulatory agencies has led to a considerable success in countering the SFM pandemic, there is need to amplify and intensify such efforts in order to curb or totally eradicate the menace. Here, we provide an overview of the detrimental impact of SFM on the healthcare system in African countries and highlight various strategies for curbing the menace in order to arrest its hazardous consequence to the public

Assessment of COVID-19 information overload among the general public

Background A relentless flood of information accompanied the novel coronavirus 2019 (COVID-19) pandemic. False news, conspiracy theories, and magical cures were shared with the general public at an alarming rate, which may lead to increased anxiety and stress levels and associated debilitating consequences. Objectives To measure the level of COVID-19 information overload (COVIO) and assess the association between COVIO and sociodemographic characteristics among the general public. Methods A cross-sectional online survey was conducted between April and May 2020 using a modified Cancer Information Overload scale. The survey was developed and posted on four social media platforms. The data were only collected from those who consented to participate. COVIO score was classified into high vs. low using the asymmetrical distribution as a guide and conducted a binary logistic regression to examine the factors associated with COVIO. Results A total number of 584 respondents participated in this study. The mean COVIO score of the respondents was 19.4 (± 4.0). Sources and frequency of receiving COVID-19 information were found to be significant predictors of COVIO. Participants who received information via the broadcast media were more likely to have high COVIO than those who received information via the social media (adjusted odds ratio ([aOR],14.599; 95% confidence interval [CI], 1.608–132.559; p = 0.017). Also, participants who received COVID-19 information every minute (aOR, 3.892; 95% CI, 1.124–13.480; p = 0.032) were more likely to have high COVIO than those who received information every week. Conclusion The source of information and the frequency of receiving COVID-19 information were significantly associated with COVIO. The COVID-19 information is often conflicting, leading to confusion and overload of information in the general population. This can have unfavorable effects on the measures taken to control the transmission and management of COVID-19 infection