BACKGROUND: Guidelines for pharmacy practitioners regarding various clinical pharmacy activities have been published in a number of countries. There is a need to review the guidelines and identify the scope of activities covered as a prelude to developing internationally acceptable common guidelines. AIM: To review the scope of clinical pharmacy guidelines and assess the extent to which these guidelines conform to quality standards as per the AGREE II instrument. METHOD: Medline, Embase, Guideline Central, International Pharmaceutical Abstracts, Google Scholar and Google (for grey literature) were searched for the period 2010 to January 2023. Guidelines which focused on any health care setting and any clinical pharmacy activity were included. Data were extracted and quality assessed independently by two reviewers using the English version of the AGREE II instrument. RESULTS: Thirty-eight guidelines were included, mostly originating from Australia (n = 10), Ireland (n = 8), UK (n = 7) and USA (n = 5). Areas covered included medication reconciliation, medicines optimisation, medication management and transition of care. As per the AGREE II assessment, the highest score was obtained for the scope and purpose domain and the lowest score for rigour of development, mainly due to non-consideration of literature/evidence to inform guideline development. CONCLUSION: Clinical pharmacy guidelines development processes need to focus on all quality domains and should take a systematic approach to guideline development. Guidelines need to further emphasise person-centred care and clinical communication. There is a scope to harmonise the guidelines internationally considering the diverse practices, standards and legislations across different geographies.

• MeSH
• farmacie * MeSH
• komunikace * MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• systematický přehled MeSH
• Geografické názvy
• Austrálie MeSH
• Irsko MeSH

It is unknown whether the currently known risk factors of multiple sclerosis reflect the etiology of progressive-onset multiple sclerosis (POMS) as observational studies rarely included analysis by type of onset. We designed a case-control study to examine associations between environmental factors and POMS and compared effect sizes to relapse-onset MS (ROMS), which will offer insights into the etiology of POMS and potentially contribute to prevention and intervention practice. This study utilizes data from the Primary Progressive Multiple Sclerosis (PPMS) Study and the Australian Multi-center Study of Environment and Immune Function (the AusImmune Study). This report outlines the conduct of the PPMS Study, whether the POMS sample is representative, and the planned analysis methods. The study includes 155 POMS, 204 ROMS, and 558 controls. The distributions of the POMS were largely similar to Australian POMS patients in the MSBase Study, with 54.8% female, 85.8% POMS born before 1970, mean age of onset of 41.44 ± 8.38 years old, and 67.1% living between 28.9 and 39.4° S. The POMS were representative of the Australian POMS population. There are some differences between POMS and ROMS/controls (mean age at interview: POMS 55 years vs. controls 40 years; sex: POMS 53% female vs. controls 78% female; location of residence: 14.3% of POMS at a latitude ≤ 28.9°S vs. 32.8% in controls), which will be taken into account in the analysis. We discuss the methodological issues considered in the study design, including prevalence-incidence bias, cohort effects, interview bias and recall bias, and present strategies to account for it. Associations between exposures of interest and POMS/ROMS will be presented in subsequent publications.

• MeSH
• chronicko-progresivní roztroušená skleróza * epidemiologie   etiologie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• multicentrické studie jako téma MeSH
• recidiva MeSH
• rizikové faktory MeSH
• roztroušená skleróza * epidemiologie   etiologie   MeSH
• studie případů a kontrol MeSH
• věk při počátku nemoci MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Austrálie MeSH

INTRODUCTION: The non-intoxicating plant-derived cannabinoid, cannabidiol (CBD), has demonstrated therapeutic potential in a number of clinical conditions. Most successful clinical trials have used relatively high (≥300 mg) oral doses of CBD. Relatively few studies have investigated the efficacy of lower (<300 mg) oral doses, typical of those available in over-the-counter CBD products. METHODS: We present a protocol for a randomised, double-blind, placebo-controlled, parallel-group clinical trial investigating the effects of a low oral dose (150 mg) of CBD on acute psychosocial stress, situational anxiety, motion sickness and cybersickness in healthy individuals. Participants (n=74) will receive 150 mg of CBD or a matched placebo 90 min before completing three virtual reality (VR) challenges (tasks) designed to induce transient stress and motion sickness: (a) a 15 min 'Public Speaking' task; (b) a 5 min 'Walk the Plank' task (above a sheer drop); and (c) a 5 min 'Rollercoaster Ride' task. The primary outcomes will be self-reported stress and nausea measured on 100 mm Visual Analogue Scales. Secondary outcomes will include salivary cortisol concentrations, skin conductance, heart rate and vomiting episodes (if any). Statistical analyses will test the hypothesis that CBD reduces nausea and attenuates subjective, endocrine and physiological responses to stress compared with placebo. This study will indicate whether low-dose oral CBD has positive effects in reducing acute psychosocial stress, situational anxiety, motion sickness and cybersickness. ETHICS AND DISSEMINATION: The University of Sydney Human Research Ethics Committee has granted approval (2023/307, version 1.6, 16 February 2024). Study findings will be disseminated in a peer-reviewed journal and at academic conferences. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12623000872639).

• MeSH
• dvojitá slepá metoda MeSH
• kanabidiol * terapeutické užití   MeSH
• kinetózy * farmakoterapie   MeSH
• lidé MeSH
• nauzea farmakoterapie   MeSH
• psychický stres MeSH
• randomizované kontrolované studie jako téma MeSH
• úzkost farmakoterapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• protokol klinické studie MeSH
• Geografické názvy
• Austrálie MeSH

Yaws is an endemic disease caused by Treponema pallidum subsp. pertenue (TPE) that primarily affects children in rural regions of the tropics. The endemic character of yaws infections and the expected exclusive reservoir of TPE in humans opened a new opportunity to start a yaws eradication campaign. We have developed a multi-locus sequence typing (MLST) scheme for TPE isolates combining the previously published (TP0548, TP0488) and new (TP0858) chromosomal loci, and we compared this typing scheme to the two previously published MLST schemes. We applied this scheme to TPE-containing clinical isolates obtained during a mass drug administration study performed in the Namatanai District of Papua New Guinea between June 2018 and December 2019. Of 1081 samples collected, 302 (28.5%) tested positive for TPE DNA, from which 255 (84.4%) were fully typed. The TPE PCR-positivity in swab samples was higher in younger patients, patients with single ulcers, first ulcer episodes, and with ulcer duration less than six months. Non-treponemal serological test positivity correlated better with PCR positivity compared to treponema-specific serological tests. The MLST revealed a low level of genetic diversity among infecting TPE isolates, represented by just three distinct genotypes (JE11, SE22, and TE13). Two previously used typing schemes revealed similar typing resolutions. Two new alleles (one in TP0858 and one in TP0136) were shown to arise by intragenomic recombination/deletion events. Compared to samples genotyped as JE11, the minor genotypes (TE13 and SE22) were more frequently detected in samples from patients with two or more ulcers and patients with higher values of specific TP serological tests. Moreover, the A2058G mutation in the 23S rRNA genes of three JE11 isolates was found, resulting in azithromycin resistance.

• MeSH
• dítě MeSH
• frambézie * epidemiologie   MeSH
• genotyp MeSH
• lidé MeSH
• multilokusová sekvenční typizace MeSH
• mutace MeSH
• Treponema pallidum * genetika   MeSH
• Treponema genetika   MeSH
• vřed MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Papua Nová Guinea MeSH

Úvod: Senioři s demencí jsou vysoce závislí na pečovatelích; jak nemoc postupuje a její závažnost se zvyšuje, vyžadují větší pomoc a dohled. Rodinní pečovatelé mají různé reakce na péči o seniory s demencí. Cílem této studie bylo prozkoumat reakce indonéských rodinných pečovatelů na péči o seniory s demencí. Metody: Pro tuto studii byl vybrán kvalitativní výzkumný design. Na základě polostrukturovaných rozhovorů byla provedena deskriptivní fenomenologická studie mezi 15 účelově vybranými rodinnými pečovateli. Výsledky: Z dat vyplynula tři hlavní témata a osm podtémat. Prvním tématem bylo vnímání demence ze strany rodinných pečovatelů. Dílčími tématy bylo, že demence je běžné onemocnění způsobené procesem stárnutí a demence je onemocnění způsobené Parkinsonovou chorobou, mrtvicí, stresem a osamělostí. Druhým tématem byl smysl péče o seniory s demencí. Dílčími tématy byly povinnost pečovat o seniory s demencí, forma filiální zbožnosti a duchovní smysl péče o seniory s demencí. Třetím tématem byl proces přijetí do role pečovatele o seniora s demencí. Dílčími tématy byly popírání, deprese a přijímání. Závěr: Každé z těchto témat má kulturní a duchovní rozměr a pečovatelé vyžadují odbornou pomoc zdravotníků, která odpovídá těmto rozměrům péče. Stejně tak je důležité identifikovat depresi u rodinných pečovatelů, aby mohly být poskytnuty vhodné intervence

Introduction: Elderly people with dementia are highly dependent on caregivers; they require more assistance and supervision as the disease progresses and its severity increases. Family caregivers have different responses to caring for elderly people with dementia. This study aimed to explore Indonesian family caregivers' responses to caring for elderly people with dementia. Methods: A qualitative research design was selected for this study. On the basis of semi-structured interviews, a descriptive phenomenological study was conducted among 15 purposively-recruited family caregivers. Results: Three main themes and eight sub-themes emerged from the data. The first theme was family caregivers' perceptions of dementia. The sub-themes were that dementia is a common disease due to the aging process, and dementia is a disease due to Parkinson's, stroke, stress, and loneliness. The second theme was the meaning of caring for elderly people with dementia. The sub-themes were that obligation to care for older people with dementia, form of filial piety and the spiritual meaning of caring for older people with dementia. The third theme was the process of acceptance in taking on the role of caregiver to an elderly person with dementia. The sub-themes were that denial, depression, and acceptance. Conclusion: Each of these themes has a cultural and spiritual dimension, and caregivers require professional assistance from health workers that accounts for these dimensions of caregiving. Likewise, it is important to identify depression in family caregivers so that suitable interventions can be provided.

• MeSH
• demence * ošetřování   MeSH
• domácí ošetřování MeSH
• lidé MeSH
• osoby pečující o pacienty * psychologie   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Geografické názvy
• Indonésie MeSH

OBJECTIVE: Increasing numbers of young people attending university has raised concerns about the capacity of student mental health services to support them. We conducted a randomised controlled trial (RCT) to explore whether provision of an 8 week mindfulness course adapted for university students (Mindfulness Skills for Students-MSS), compared with university mental health support as usual (SAU), reduced psychological distress during the examination period. Here, we conduct an economic evaluation of MSS+SAU compared with SAU. DESIGN AND SETTING: Economic evaluation conducted alongside a pragmatic, parallel, single-blinded RCT comparing provision of MSS+SAU to SAU. PARTICIPANTS: 616 university students randomised. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary economic evaluation assessed the cost per quality-adjusted life year (QALY) gained from the perspective of the university counselling service. Costs relate to staff time required to deliver counselling service offerings. QALYs were derived from the Clinical Outcomes in Routine Evaluation Dimension 6 Dimension (CORE-6D) preference based tool, which uses responses to six items of the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM; primary clinical outcome measure). Primary follow-up duration was 5 and 7 months for the two recruitment cohorts. RESULTS: It was estimated to cost £1584 (2022 prices) to deliver an MSS course to 30 students, £52.82 per student. Both costs (adjusted mean difference: £48, 95% CI £40-£56) and QALYs (adjusted mean difference: 0.014, 95% CI 0.008 to 0.021) were significantly higher in the MSS arm compared with SAU. The incremental cost-effectiveness ratio (ICER) was £3355, with a very high (99.99%) probability of being cost-effective at a willingness-to-pay threshold of £20 000 per QALY. CONCLUSIONS: MSS leads to significantly improved outcomes at a moderate additional cost. The ICER of £3355 per QALY suggests that MSS is cost-effective when compared with the UK's National Institute for Health and Care Excellence thresholds of £20 000 per QALY. TRIAL REGISTRATION NUMBER: Australian and New Zealand Clinical Trials Registry, ACTRN12615001160527.

• MeSH
• analýza nákladů a výnosů MeSH
• kvalita života MeSH
• kvalitativně upravené roky života MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• psychický distres * MeSH
• studenti psychologie   MeSH
• univerzity MeSH
• všímavost * MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• Publikační typ
• časopisecké články MeSH
• pragmatická klinická studie MeSH
• randomizované kontrolované studie MeSH
• Geografické názvy
• Austrálie MeSH

Východiska: Pandemie covidu-19 může způsobit závažné klinické projevy u zranitelné populace, jako jsou těhotné ženy. Podle Indonéské asociace porodnictví a gynekologie (POGI) dosáhl počet úmrtí matek v důsledku covidu-19 od dubna 2020 do dubna 2021 3 % a od vzniku delta varianty covidu-19 vzrostl na 9 %. Tento výzkum byl navržen tak, aby identifikoval faktory spojené s úmrtností těhotných žen s covidem-19. Materiál a metody: Jednalo se o průřezovou studii využívající sekundární data shromážděná od června 2020 do srpna 2021. Studie byla provedena v Universitas Indonesia Hospital, národní referenční nemocnici pro covid-19. Hodnotila se charakteristika pacientky, profil těhotenství, komorbidity, laboratorní výsledky, RTG vyšetření hrudníku, možnosti léčby a závažnost symptomů. Kromě toho byla provedena bivariační analýza dat pomocí SPSS. Výsledky: Ze 114 výzkumných subjektů sedm pacientek (6,1 %) zemřelo a 107 pacientek (93,9 %) přežilo. Riziko úmrtnosti významně (p < 0,05) souviselo s věkem pacientky, délkou hospitalizace, gestačním věkem, závažností covidu-19, hladinou hemoglobinu, počtem leukocytů, počtem krevních destiček, lymfocytů, hladinami D-dimerů, C-reaktivním proteinem, transaminázovými enzymy, močovinou, kreatininem, eGFR, sodíkem, draslíkem a prokalcitoninem. Kromě toho byly také prokázány významné rozdíly (p < 0,05) související s úmrtností matek v přítomnosti komorbidit (diabetes 2. typu, městnavé srdeční selhání, ischemická choroba srdeční/akutní koronární syndrom a infekce močových cest) a při užívaní steroidů a tocilizumabu. Závěr: S úmrtností těhotných žen na covid-19 jsou významně spojeny různé faktory. Tato studie může tvořit základ pro další studie s větším počtem subjektů, modifikovat hodnocení a management těhotných žen s covidem-19 a následně snížit úmrtnost těhotných žen.

Background: The covid-19 pandemic may cause severe clinical manifestations in a vulnerable population, such as pregnant women. Based on Indonesian Obstetrics and Gynecology Association (POGI), the number of maternal deaths due to covid-19 from April 2020 to April 2021 reached 3% and increased to 9% since the delta variant of covid-19 emerged. This research was expected to identify factors that are related to the mortality rate of pregnant women with covid-19. Materials and methods: This was a cross-sectional study using secondary data collected from June 2020 to August 2021. The study was conducted in Universitas Indonesia Hospital, a national covid-19 referral hospital. Patient characteristics, pregnancy profile, comorbidities, laboratory results, chest X-ray examination, treatment options, and the severity of symptoms were evaluated. In addition, bivariate data analysis was carried out using the SPSS device. Results: Out of 114 research subjects, seven patients (6.1%) died, and 107 patients (93.9%) survived. The risk of mortality was significantly (P < 0.05) related to patients’ age, duration of hospitalization, gestational age, severity rate of covid-19, the level of hemoglobin, leukocyte count, platelet count, lymphocytes, the levels of D-dimer, C-reactive protein, transaminase enzymes, urea, creatinine, eGFR, sodium, potassium, and procalcitonin. In addition, significant differences (P < 0.05) related to maternal mortality rate were also shown in the presence of comorbidities (type 2 diabetes, congestive heart failure, coronary artery disease/acute coronary syndrome, and urinary tract infection), and the use of steroids and tocilizumab. Conclusion: Various factors significantly related to the mortality rate of pregnant women with covid-19. This study may become the basis for a further study with a larger number of subjects, adjustment of assessment and management of covid-19 infected pregnant women, thus hopefully reducing the risk of mortality in pregnant women with covid-19.

• MeSH
• COVID-19 * mortalita   MeSH
• komplikace těhotenství * mortalita   MeSH
• lidé MeSH
• průřezové studie MeSH
• rizikové faktory MeSH
• statistika jako téma MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Geografické názvy
• Indonésie MeSH

INTRODUCTION: Poor adoption of stroke guidelines is a problem internationally. The Quality in Acute Stroke Care (QASC) trial demonstrated significant reduction in death and disability with facilitated implementation of nurse-initiated. METHODS: This was a multi-country, multi-centre, pre-test/post-test study (2017-2021) comparing post implementation data with historically collected pre-implementation data. Hospital clinical champions, supported by the Angels Initiative conducted multidisciplinary workshops discussing pre-implementation medical record audit results, barriers and facilitators to FeSS Protocol implementation, developed action plans and provided education, with ongoing support co-ordinated remotely from Australia. Prospective audits were conducted 3-month after FeSS Protocol introduction. Pre-to-post analysis and country income classification comparisons were adjusted for clustering by hospital and country controlling for age/sex/stroke severity. RESULTS: Data from 64 hospitals in 17 countries (3464 patients pre-implementation and 3257 patients post-implementation) showed improvement pre-to-post implementation in measurement recording of all three FeSS components, all p < 0.0001: fever elements (pre: 17%, post: 51%; absolute difference 33%, 95% CI 30%, 37%); hyperglycaemia elements (pre: 18%, post: 52%; absolute difference 34%; 95% CI 31%, 36%); swallowing elements (pre: 39%, post: 67%; absolute difference 29%, 95% CI 26%, 31%) and thus in overall FeSS Protocol adherence (pre: 3.4%, post: 35%; absolute difference 33%, 95% CI 24%, 42%). In exploratory analysis of FeSS adherence by countries' economic status, high-income versus middle-income countries improved to a comparable extent. DISCUSSION AND CONCLUSION: Our collaboration resulted in successful rapid implementation and scale-up of FeSS Protocols into countries with vastly different healthcare systems.

• MeSH
• cévní mozková příhoda * diagnóza   MeSH
• horečka diagnóza   MeSH
• hyperglykemie * diagnóza   MeSH
• lidé MeSH
• polykání MeSH
• poruchy polykání * diagnóza   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Austrálie MeSH

In response to escalating cases of serogroup W (MenW) invasive meningococcal disease (IMD), multiple countries introduced quadrivalent conjugate MenACWY vaccines into their national immunization programs (NIPs). Here, we summarize the real-world impact and vaccine effectiveness (VE) data of MenACWY-TT from Chile, England, the Netherlands, and Australia. Incidence rate reductions (IRRs) and VE from baseline to post-NIP period were extracted from publications or calculated. After the administration of a single dose of MenACWY-TT, substantial IRRs of MenCWY were observed across the countries in vaccine-eligible age groups (83%-85%) and via indirect protection in non-vaccine-eligible age groups (45%-53%). The impact of MenACWY-TT was primarily driven by MenW IRRs, as seen in vaccine-eligible age groups (65%-92%) and non-vaccine-eligible age groups (41%-57%). VE against MenW was reported in vaccine-eligible toddlers (92%) in the Netherlands and in vaccine-eligible adolescents/young adults (94%) in England. These real-world data support the implementation and continued use of MenACWY-TT in NIPs.

• MeSH
• kombinované vakcíny MeSH
• lidé MeSH
• meningokokové infekce * epidemiologie   prevence a kontrola   MeSH
• mladiství MeSH
• mladý dospělý MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• Geografické názvy
• Anglie MeSH
• Austrálie MeSH
• Nizozemsko MeSH

OBJECTIVES: Determine community needs and perspectives as part of planning health service incorporation into Wanang Conservation Area, in support of locally driven sustainable development. DESIGN: Clinical and rapid anthropological assessment (individual primary care assessments, key informant (KI) interviews, focus groups (FGs), ethnography) with treatment of urgent cases. SETTING: Wanang (pop. c189), a rainforest community in Madang province, Papua New Guinea. PARTICIPANTS: 129 villagers provided medical histories (54 females (f), 75 males (m); median 19 years, range 1 month to 73 years), 113 had clinical assessments (51f, 62m; median 18 years, range 1 month to 73 years). 26 ≥18 years participated in sex-stratified and age-stratified FGs (f<40 years; m<40 years; f>40 years; m>40 years). Five KIs were interviewed (1f, 4m). Daily ethnographic fieldnotes were recorded. RESULTS: Of 113 examined, 11 were 'well' (a clinical impression based on declarations of no current illness, medical histories, conversation, no observed disease signs), 62 (30f, 32m) were treated urgently, 31 referred (15f, 16m), indicating considerable unmet need. FGs top-4 ranked health issues concorded with KI views, medical histories and clinical examinations. For example, ethnoclassifications of three ((A) 'malaria', (B) 'sotwin', (C) 'grile') translated to the five biomedical conditions diagnosed most ((A) malaria, 9 villagers; (B) upper respiratory infection, 25; lower respiratory infection, 10; tuberculosis, 9; (C) tinea imbricata, 15) and were highly represented in declared medical histories ((A) 75 participants, (B) 23, (C) 35). However, 29.2% of diagnoses (49/168) were limited to one or two people. Treatment approaches included plant medicines, stored pharmaceuticals, occasionally rituals. Travel to hospital/pharmacy was sometimes undertaken for severe/refractory disease. Service barriers included: no health patrols/accessible aid post, remote hospital, unfamiliarity with institutions and medicine costs. Service introduction priorities were: aid post, vaccinations, transport, perinatal/birth care and family planning. CONCLUSIONS: This study enabled service planning and demonstrated a need sufficient to acquire funding to establish primary care. In doing so, it aided Wanang's community to develop sustainably, without sacrificing their forest home.

• MeSH
• deštný prales * MeSH
• dospělí MeSH
• lidé MeSH
• zdravotnické služby * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Papua Nová Guinea MeSH