The effect of pharmacist-led medication therapy management in the multidisciplinary care of acute kidney injury survivors.

BACKGROUND: The Acute Disease Quality Initiative advocates multidisciplinary care for the survivors of acute kidney injury (AKI). The bundled care strategy recognizes the role of pharmacists. However, their specific contributions in this context remain underexplored. METHODS: This retrospective study examined the efficacy of pharmacist-led post-AKI pharmaceutical care in outpatient settings at a single center. Adults with recent AKI during hospitalization, maintaining an estimated glomerular filtration rate <45 mL/min/1.73 m2 postdischarge, were enrolled in a multidisciplinary team care program from March 2022 to January 2023, with a 6-month follow-up period. Pharmacist-delivered care adhered to international multidisciplinary consensus guidelines. Efficacy was evaluated by analyzing medication-related recommendations, medication adherence, nephrotoxic drug utilization, and renoprotective medication usage before and after the intervention. RESULTS: A total of 40 patients were referred to the pharmacist-managed clinic. Of these, 33 patients (mean age, 63 ± 15 years; 60.6% male) attended the clinic. Nineteen patients completed follow-up visits. The pharmacist provided 14 medication-related recommendations to relevant physicians, with 10 of these recommendations (71.4%) being accepted. There was a significant decrease in the use of modifiable nephrotoxic drugs (p = 0.03). However, no significant improvements were noted in medication adherence or the utilization of renoprotective medications. CONCLUSION: Our study underscores the potential benefits of pharmacist-led post-AKI bundled care strategy in outpatient settings. We observed a significant reduction in the utilization of modifiable nephrotoxic drugs, indicating the effectiveness of pharmacist interventions in optimizing medication regimens to mitigate renal harm.

Unveiling the enigma of acute kidney disease: predicting prognosis, exploring interventions, and embracing a multidisciplinary approach.

Acute kidney disease (AKD) is a critical transitional period between acute kidney injury and chronic kidney disease. The incidence of AKD following acute kidney injury is approximately 33.6%, and it can occur without identifiable preceding acute kidney injury. The development of AKD is associated with increased risks of chronic kidney disease, dialysis, and mortality. Biomarkers and subphenotypes are promising tools to predict prognosis in AKD. The complex clinical situations in patients with AKD necessitate a comprehensive and structured approach, termed "KAMPS" (kidney function check, advocacy, medications, pressure, sick day protocols). We introduce "MAND-MASS," an acronym devised to summarize the reconciliation of medications during episodes of acute illness, as a critical component of the sick day protocols at AKD. A multidisciplinary team care, consisting of nephrologists, pharmacists, dietitians, health educators, and nurses, is an optimal model to achieve the care bundle in KAMPS. Although the evidence for patients with AKD is still lacking, several potential pharmacological agents may improve outcomes, including but not limited to angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, sodium-glucose cotransporter 2 inhibitors, and glucagon-like peptide 1 receptor agonists. In conclusion, accurate prognosis prediction and effective treatment for AKD are critical yet unmet clinical needs. Future studies are urgently needed to improve patient care in this complex and rapidly evolving field.

Unraveling stroke gait deviations with movement analytics, more than meets the eye: a case control study.

Background: This study aimed to identify and quantify the kinematic and kinetic gait deviations in post-stroke hemiplegic patients with matched healthy controls using Statistical Parametric Mapping (SPM). Methods: Fifteen chronic stroke patients [4 females, 11 males; age 53.7 (standard deviation 12.2) years; body mass 65.4 (10.4) kg; standing height 168.5 (9.6) cm] and 15 matched healthy controls [4 females, 11 males; age 52.9 (11.7) years; body weight 66.5 (10.7) years; standing height 168.3 (8.8) cm] were recruited. In a 10-m walking task, joint angles, ground reaction forces (GRF), and joint moments were collected, analyzed, and compared using SPM for an entire gait cycle. Results: Generally, when comparing the stroke patients' affected (hemiplegic) and less-affected (contralateral) limbs with the control group, SPM identified significant differences in the late stance phase and early swing phase in the joint angles and moments in bilateral limbs (all p < 0.005). In addition, the vertical and anteroposterior components of GRF were significantly different in various periods of the stance phase (all p < 0.005), while the mediolateral component showed no differences between the two groups. Conclusion: SPM was able to detect abnormal gait patterns in both the affected and less-affected limbs of stroke patients with significant differences when compared with matched controls. The findings draw attention to significant quantifiable gait deviations in the less-affected post-stroke limb with the potential impact to inform gait retraining strategies for clinicians and physiotherapists.

Causal Model Analysis of the Effect of Formalism, Fear of Infection, COVID-19 Stress on Firefighters' Post-Traumatic Stress Syndrome and Insomnia.

As the front line of epidemic prevention, firefighters are responsible for the transportation of infected cases. Firefighters are under a lot of stress from the new COVID-19, especially the fear that they may contract the virus at work and spread the virus to their families. In particular, the framework of this study incorporates Riggs' formalism variables. When firefighters think that the epidemic prevention regulations are inconsistent with the actual epidemic prevention, it will increase their work pressure on COVID-19. In this study, firefighters from all over Taiwan were used as the respondents, and a total of 453 respondents were obtained. This study uses confirmatory factor analysis and structural equation modeling to test the established hypotheses. The findings confirm that formalism, fear of self and family infection are positively influencing COVID-19 stress. COVID-19 stress positively affects PTSD and insomnia. COVID-19 stress negatively affects problem-focused strategies. Problem-focused strategies negatively affect post-traumatic stress disorder.

Medical alert management: a real-time adaptive decision support tool to reduce alert fatigue.

With the adoption of electronic medical records (EMRs), drug safety alerts are increasingly recognized as valuable tools for reducing adverse drug events and improving patient safety. However, even with proper tuning of the EMR alert parameters, the volume of unfiltered alerts can be overwhelming to users. In this paper, we design an adaptive decision support tool in which past cognitive overriding decisions of users are learned, adapted and used for filtering actions to be performed on current alerts. The filters are designed and learned based on a moving time window, number of alerts, overriding rates, and monthly overriding fluctuations. Using alerts from two separate years to derive filters and test performance, predictive accuracy rates of 91.3%-100% are achieved. The moving time window works better than a static training approach. It allows continuous learning and capturing of the most recent decision characteristics and seasonal variations in drug usage. The decision support system facilitates filtering of non-essential alerts and adaptively learns critical alerts and highlights them prominently to catch providers' attention. The tool can be plugged into an existing EMR system as an add-on, allowing real-time decision support to users without interfering with existing EMR functionalities. By automatically filtering the alerts, the decision support tool mitigates alert fatigue and allows users to focus resources on potentially vital alerts, thus reducing the occurrence of adverse drug events.

Isolation of motile spermatozoa with a microfluidic chip having a surface-modified microchannel.

Conventional methods to prepare sperm have been amenable to the investigation of outcomes such as rates of recovery and conventional semen parameters. The standard preparation of sperm for assisted reproduction is criticized for its centrifugation steps, which might either recover motile sperm in variable proportions or increase the probability of damage to sperm DNA. An microfluidic system was designed to separate motile sperm according to a design whereby nonmotile spermatozoa and debris flow along their initial streamlines and exit through one outlet-up, whereas motile spermatozoa have an opportunity to swim into a parallel stream and to exit through a separate outlet-down. This chip was fabricated by microelectromechanical systems technology with polydimethylsiloxane molding. The hydrophilic surface, coated with poly (ethanediol) methyl ether methacrylate, exhibits enduring stability maintained for the microchannel. Microscopic examination and fluorescent images showed that the motility of sperm varied with the laminar streams. To confirm the sorting, we identified and quantified the proportions of live and dead sperm before and after sorting with flow cytometric analysis. The results on the viability of a sample demonstrated the increased quality of sperm after sorting and collection in the outlet reservoir. The counted ratio of live sperm revealed the quantity and efficiency of the sorted sperm.

Utilizing isotope dilution-matrix-assisted laser desorption ionization-time of flight mass spectrometry as a reference procedure for the radioimmunoassay of serum thyroxine.

BACKGROUND: The thyroid hormone, thyroxine (T4), is a tyrosine-based hormone produced by the thyroid gland, which is essential in regulating a number of biological processes, including growth, neurodevelopment, carbohydrate metabolism, oxygen consumption and protein synthesis. Data on human thyroid hormone metabolism were gathered since the middle of the 1970s mainly by the use of radioactive iodinated ((125)I or (131)I) hormones. METHODS: We describe an isotope dilution-matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) method for the simultaneous determination of endogenous thyroid hormone and its (13)C6-labeled analogue in serum. The (13)C6-thyroxine ((13)C6-T4) was used as an internal standard; T4 and its isotopically labeled analogue were measured in the selected reaction monitoring mode for the transitions from m/z 777.8 to 732.1 and from m/z 784.2 to 738.1, respectively. RESULTS: Serum samples were prepared and concentrated by a solid-phase extraction chromatography method. The recovery rate was measured by (125)I-T4 and can be up to 82.8±2.8%. The detection limit and linear range for T4 were 5 ng/ml and 5-400 ng/ml, respectively. The correlation coefficient (R(2)) between radioimmunoassay (RIA) and isotope dilution-MALDI-TOF MS for detection of serum T4 was 0.982. CONCLUSION: This assay has a good relationship against a commercial RIA and the isotope dilution-mass spectrometry method and may serve as a reference method for quantitative analysis of T4.