Antidepressants : a content analysis of healthcare providers' tweets

This study aims to analyse the Twitter posts of healthcare providers related to antidepressants after the impact of the COVID-19 pandemic and to explore the healthcare providers’ engagement and their areas of interest

Antidepressants : a content analysis of healthcare providers' tweets

Background -- Antidepressants are the primary treatment for depression, and social support from social media may offer another support route. Whilst Twitter has become an interactive platform for healthcare providers and their patients, previous studies found low engagement of healthcare providers when discussing antidepressants on Twitter. This study aims to analyse the Twitter posts of healthcare providers related to antidepressants and to explore the healthcare providers' engagement and their areas of interest. Method -- Tweets within a 10-day period were collected through multiple searches with a list of keywords within Twitter. The results were filtered against several inclusion criteria, including a manual screening to identify healthcare providers. A content analysis was conducted on eligible tweets where correlative themes and subthemes were identified. Key findings -- Healthcare providers contributed 5.9% of the antidepressant-related tweets (n = 770/13,005). The major clinical topics referred to in the tweets were side effects, antidepressants for the treatment of COVID-19, and antidepressant studies of psychedelics. Nurses posted more tweets sharing personal experiences with commonly negative attitudes, in contrast to physicians. Links to external webpages were commonly used among healthcare providers, especially users representing healthcare organisations. Conclusions -- A relatively low proportion of healthcare providers' engagement on Twitter regarding antidepressants (5.9%) was identified, with a minimal increase throughout the COVID-19 pandemic when compared to previous studies. The major clinical topics referred to in the tweets were side effects, antidepressants for the treatment of COVID-19 and antidepressant studies of psychedelics, which have been made publicly available. In general, the findings confirmed that social media platforms are a mechanism by which healthcare providers, organisations and students support patients, share information about adverse drug effects, communicate personal experiences, and share research. It is plausible that this could impact the belief and behaviours of people with lived experience of depression who may see these tweets

What does Twitter say about COVID-19 vaccines?

Background and objectives: Vaccines to reduce the level of hospitalisations and death from COVID-19 became available in certain countries from December 2020. This study aimed to analyse social media content shared on Twitter regarding COVID-19 vaccines on a random day to obtain insights into publicly expressed opinions on these vaccines. Method: English language tweets, regardless of country of origin, were collected through NCapture from a 24-hour time period between 06/11/2022 and 07/11/2022 using the search term “COVID-19 vaccines”. NVivo aided content analysis was conducted on all obtained tweets; tweets unrelated to the study aim were coded as irrelevant and subsequently excluded from analysis. The study was exploratory in nature, without an underlying hypothesis. Results: Overall, 1284 tweets were captured. A total of 67 different codes were created with 50 of those directly relating to opinions and/or information about COVID-19 vaccines; 41.8% of which were negative and 34.3% positive. Positive tweets related to, e.g., encouraging the public to get the vaccine; reductions in COVID-19 related health burdens; and providing links to scientific studies. In contrast, negative tweets warned of potential dangers associated with vaccines, primarily highlighting side effects; and reiterated prevalent conspiracy theories. Conclusion: Overall, opinions on Twitter regarding COVID-19 vaccines showed considerable variation on the day the tweets were captured. Nevertheless, there was a notable number of tweets providing links to reliable studies on COVID-19 vaccines, indicating that many Twitter users may aim to provide reliable information regarding COVID-19 vaccines

An umbrella review and quality assessment of renin-angiotensin system drugs use and Covid-19 outcomes : wat is the quality of the research evidence?

Background: During 2020, an extensive number of reviews were published on the effect of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin-receptor blockers (ARBs) on COVID-19 outcomes, yet the evidence appeared heterogenous. We conducted a meta-analysis and quality assessment of these reviews. Methods: An umbrella review was conducted. Medline, Embase, Scopus, Cochrane library and medRxiv were searched on 1 February 2021. The AMSTAR 2 Critical Appraisal Tool assessed study quality. The Corrected Cover Area (CCA) calculated the degree of study overlap within the reviews. Results: In 2020/21, 47 reviews on this topic were conducted. The overall confidence in the results was most commonly ‘critically low’ (n=22, 44.9%), followed by ‘low’ (n=15, 30.6%) and ‘moderate’ (n=10, 21.3%). A minority (n=15, 31.9%) established a review protocol a priori. The CCA value was 9.2 indicating a moderate degree of study overlap, yet this analysis was complicated by three studies not fully reporting included studies. In total, 168 studies were known to have been included within the reviews. Most (n = 99) were included in three or less reviews, yet one study was included within 37 reviews. Collective evidence indicated good quality evidence on the significant association between ACEIs/ARBs use and reduction in death and death/ICU admission, but poor-quality evidence on reducing severe COVID-19 and increasing hospitalisation. Conclusions: The superfluous research activities are likely related to the collective interest in the topic, and limited development of review protocols a-priori. Despite quality concerns, our findings do support not discontinuing ACEIs/ARBs therapy in patients with COVID-19

An umbrella review and meta-analysis of renin-angiotensin system drugs use and COVID-19 outcomes

Abstract: Background: Despite the availability of extensive literature on the effect of angiotensin‐converting enzyme inhibitors (ACEIs)/angiotensin‐receptor blockers (ARBs) on COVID‐19 outcomes, the evidence is still controversial. We aimed to provide a comprehensive assessment of the effect of ACEIs/ARBs on COVID‐19‐related outcomes by summarising the currently available evidence. Methods: An umbrella review was conducted using Medline (OVID), Embase, Scopus, Cochrane library and medRxiv from inception to 1 February 2021. Systematic reviews with meta‐analysis that evaluated the effect of ACEIs/ARBs on COVID‐19‐related clinical outcomes were eligible. Studies' quality was appraised using the AMSTAR 2 Critical Appraisal Tool. Data were analysed using the random‐effects modelling including several subgroup analyses. Heterogenicity was assessed using I2 statistic. The study protocol was registered in PROSPERO (CRD42021233398) and reported using PRISMA guidelines. Results: Overall, 47 reviews were eligible for inclusion. Out of the nine COVID‐19 outcomes evaluated, there was significant associations between ACEIs/ARBs use and each of death (OR = 0.80, 95%CI = 0.75–0.86; I2 = 51.9%), death/ICU admission as composite outcome (OR = 0.86, 95%CI = 0.80–0.92; I2 = 43.9%), severe COVID‐19 (OR = 0.86, 95%CI = 0.78–0.95; I2 = 68%) and hospitalisation (OR = 1.23, 95%CI = 1.04–1.46; I2 = 76.4%). The significant reduction in death/ICU admission, however, was higher among studies which presented adjusted measure of effects (OR = 0.63, 95%CI = 0.47–0.84) and were of moderate quality (OR = 0.74, 95%CI = 0.63–0.85). Conclusions: Collective evidence from observational studies indicate a good quality evidence on the significant association between ACEIs/ARBs use and reduction in death and death/ICU admission, but poor‐quality evidence on both reducing severe COVID‐19 and increasing hospitalisation. Our findings further support the current recommendations of not discontinuing ACEIs/ARBs therapy in patients with COVID‐19

The real-world use of drugs for the management of cancer in pediatric population : a scoping review protocol

Objective: The objective of the forthcoming scoping review is to investigate and describe the actual management of pediatric cancer patients who access various clinical settings. Introduction: The overall cancer management with the aid of drugs is a multifaceted process to treat the diagnosed patients, which is usually along with another treatment modalities. This process also involves controlling the emerged harmful symptoms attributed to cancer or cancer treatment using drugs in an effort to enhance patients’ experience during treatment course and improve their quality of life, besides avoiding the long-lasting detrimental clinical impact. Inclusion criteria: All observational studies that focus on the use of drugs in cancer patients age

Universal and Programmable Thinning and Thickening of Topologically-Active DNA Fluids

Understanding and controlling the rheology of polymeric fluids that are out-of-equilibrium is a fundamental problem in biology and industry. For example, to package, repair, and replicate DNA, cells use enzymes to constantly manipulate DNA topology, length, and structure. Inspired by this impressive feat, we combine experiments with theory and simulations to show that complex fluids of entangled DNA display a rich range of non-equilibrium material properties when undergoing enzymatic reactions that alter their topology and size. We reveal that while enzymatically-active fluids of linear DNA display universal viscous thinning, circular DNA fluids - undergoing the same non-equilibrium process - display thickening with a rate and degree that can be tuned by the DNA and enzyme concentrations. Our results open the way for the topological functionalization of DNA-based materials via naturally occurring enzymes to create a new class of "topologically-active" materials that can autonomously alter their rheological properties in a programmable manner

Identifying the important outcomes to measure for pharmacy-led, clinical services within primary care : a nominal group technique approach

Background The introduction of clinical pharmacy services is part of a multi-disciplinary approach to reduce pressure on primary care. Ascertaining the impact of clinical pharmacists in general practice is vital to ensure intended benefits are achieved. However, this is complicated by poor quality evidence, multiple interventions, and a lack of agreement regarding outcome measures. Objectives To develop an outcomes framework for clinical pharmacy services delivered in Scottish general practice using a consensus methodology. Methods A modified nominal group technique (NGT) was conducted using Microsoft Teams and Qualtrics. This involved a pre-NGT questionnaire, silent generation of ideas, round robin, discussions, ranking, and a final consensus exercise. A selective sampling strategy recruited experienced pharmacists from Scottish health regions. NGT ranking results were used to signify relative importance of the outcome areas. NGT discussions underwent inductive thematic analysis to explore key areas considered. Result Overall, 13 (median: 24 years of experience) pharmacists participated, representing 11 of 14 Scottish regions. In total, 21 outcome areas, derived from the literature and a pre-NGT questionnaire, were considered during the NGT ranking exercise. Consensus identified five important outcome areas: Patient Experience, Medication Related Adverse Events, Cost-Effectiveness, Medication Optimisation, and Health Related Quality of Life. Thematic analysis highlighted the importance of the outcome framework's target audience, factors influencing the interpretation of outcomes, and the feasibility of the associated outcome measures. Conclusions The five key outcome areas will facilitate evidence-based decisions regarding service delivery. Future work should develop a measurement plan, involving routinely collected sources of outcomes data. The feasibility of collecting outcomes in the real-world context should be considered, identifying measures which are easy to collect within existing data infrastructures. This paper describes a replicable method to gain consensus for a national approach to data collection from a strong theoretical basis using an online methodology

Factors influencing national implementation of innovations within community pharmacy : a systematic review applying the consolidated framework for implementation research

Background: To meet emergent healthcare needs, innovations need to be implemented into routine clinical practice. Community pharmacy is increasingly considered a setting through which innovations can be implemented to achieve positive service and clinical outcomes. Small-scale pilot programmes often need scaled up nation-wide to affect population level change. This systematic review aims to identify facilitators and barriers to the national implementation of community pharmacy innovations. Methods: A systematic review exploring pharmacy staff perspectives of the barriers and facilitators to implementing innovations at a national level was conducted. The databases Medline, EMBASE, PsycINFO, CINAHL, and Open Grey were searched and supplemented with additional search mechanisms such as Zetoc alerts. Eligible studies underwent quality assessment, and a directed content analysis approach to data extraction was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR) to facilitate narrative synthesis. Results: Thirty-nine studies were included: 16 were qualitative, 21 applied a questionnaire design, and 2 were mixed methods. Overarching thematic areas spanning across the CFIR domains were pharmacy staff engagement (e.g. their positive and negative perceptions), operationalisation of innovations (e.g. insufficient resources and training), and external engagement (e.g. the perceptions of patients and other healthcare professionals, and their relationship with the community pharmacy). Study participants commonly suggested improvements in the training offered, in the engagement strategies adopted, and in the design and quality of innovations. Conclusions: This study's focus on national innovations resulted in high-level recommendations to facilitate the development of successful national implementation strategies. These include (1) more robust piloting of innovations, (2) improved engagement strategies to increase awareness and acceptance of innovations, (3) promoting whole-team involvement within pharmacies to overcome time constraints, and (4) sufficient pre-implementation evaluation to gauge acceptance and appropriateness of innovations within real-world settings. The findings highlight the international challenge of balancing the professional, clinical, and commercial obligations within community pharmacy practice. A preliminary theory of how salient factors influence national implementation in the community pharmacy setting has been developed, with further research necessary to understand how the influence of these factors may differ within varying contexts. Trial registration: A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD42016038876)

A mixed-method study of community pharmacy staff's use, perceptions and acceptance of barcode scanning technology : pharmacy's experience of scanning technology

Introduction Increasing technology is a strategic goal within pharmacy to facilitate medicines' dispensing. Barcode scanning technology (BST) is considered low cost and reliable with potential safety benefits. A barrier to BST implementation within hospital pharmacy includes staff resistance; however, few studies explore BST within community pharmacy. To address this, pharmacy staff's use, perceptions and acceptance of BST within Scottish community pharmacies were examined. Methods Community pharmacies within Scotland using BST to scan medicines were identified using Twitter, eNewsletters and snowball sampling; 57 pharmacies were identified. Between May-Aug 2019, managers/owners participated in semi-structured interviews to explore BST use, and staff operating BST completed an online questionnaire to examine perceptions and acceptance. Interview data underwent content analysis and questionnaire data presented as medians (IQR). Results BST was used for various purposes, most commonly for dispensed item verification (n = 43 pharmacies) and to identify falsified medicines (n = 10 pharmacies). Twenty pharmacy managers/owners were interviewed which revealed multiple scanners and BST functionalities. Thirty-five participants from 16 pharmacies participated in the questionnaire. Staff considered BST as easy to use. There were positive perceptions and acceptance of BST for dispensed item verification, and negative perceptions and less acceptance of BST for identifying falsified medicines. Discussion BST implementation was identified in a minority of Scotland's 1,254 community pharmacies, and greater effort may be needed to increase technology utilisation. The variation of BST use may affect safety due to increased complexity. BST's purpose may underpin staff perceptions and acceptance. Future studies should explore barriers and observe BST use in practice. Public interest summary Barcode scanning technology (BST) may help pharmacy staff to dispense medicines safely. Hospital pharmacy staff have reported disliking using BST to scan medicines; however, no similar research has been carried out within community pharmacy. This study examined Scottish community pharmacies’ use of BST to scan medicines, and the pharmacy staff's views. Fifty-seven pharmacies were identified. BST was most commonly used to verify that the correct medicine was selected during dispensing (n = 43 pharmacies) and to identify 'falsified medicines' which were not safe to dispense (n = 10 pharmacies). Staff considered BST as easy to use, but were more positive and accepting of BST for verifying the correct medicine than for identifying falsified medicines. This suggests BST's purpose may underpin pharmacy staff perceptions and acceptance. A small number of pharmacies in Scotland used BST for this purpose, therefore more efforts may be needed to promote technology use