Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications

Psychedelic interventions for major depressive disorder in the elderly: Exploring novel therapies, promise and potential

The global population is ageing rapidly, with the number of individuals aged 60 and older reaching 1 billion in 2019 and expected to double by 2050. As people age, neuropsychological health often deteriorates, leading to a higher prevalence of age-related depression. Symptoms may include anxiety, apathy, mood instability, sadness, and, in severe cases, suicidal thoughts. Depression in the elderly is a widespread concern, and conventional treatments such as antidepressants are often limited by side effects, reduced efficacy, and complications arising from polypharmacy. In response, novel therapeutic approaches are being explored, including psychedelic interventions. Recent clinical and preclinical studies suggest that psychedelics could offer a promising treatment for major depressive disorder (MDD) in older adults. These compounds, known for their profound neurobiological effects, have gained attention for their potential to address depression where traditional therapies fall short. This review aims to examine the therapeutic promise of psychedelic substances, focusing on those that show potential for treating MDD in the elderly. We also explore the underlying mechanisms through which psychedelics may exert their effects and highlight the preclinical models that support their use. Finally, we address safety considerations and propose strategies to enhance the effectiveness and safety of psychedelics in future clinical trials, offering new hope for treating age-related depressive disorders.

Improving quercetin bioavailability: A systematic review and meta-analysis of human intervention studies

This systematic review evaluated a total of 31 included human intervention studies that have assessed methods to improve quercetin bioavailability from different formulations and food matrices using urine or blood samples up to July 2024. The bioavailability of quercetin in humans was affected by several factors. 1) Chemical structure: Quercetin-3-O-oligoglucosides exhibited 2-fold higher bioavailability than quercetin-3-O-glucoside, 10-fold higher than quercetin-3-O-rutinoside and ∼ 20-fold higher than quercetin aglycone. 2) Modification of physicochemical properties: In comparison to quercetin aglycone, the quercetin-3-O-glucoside-γ-cyclodextrin inclusion complex showed a 10.8-fold increase in bioavailability, while the self-emulsifying fenugreek galactomannans and lecithin encapsulation, and lecithin phytosome, showed a 62- and 20.1-fold increase, respectively. 3) Food matrix effects: the addition of dietary fats and fibre increased bioavailability by ∼2-fold. This review summarises key factors that enhance quercetin bioavailability, contributing to the development of more effective and practical quercetin supplements or functional foods for better bioactivity of quercetin in humans.

Drug-associated hyperprolactinemia: A comprehensive disproportionality analysis based on the FAERS database

Hyperprolactinemia (HPRL) is a clinically significant adverse event that requires careful monitoring. This study aims to identify the medications associated with HPRL using data from the FDA Adverse Event Reporting System (FAERS) between 2004Q1 and 2024Q1. Disproportionality analysis was performed to identify potential drug signals. Sensitivity analysis was conducted to assess the stability and strength of HPRL signals associated with these medications, as well as to examine signal differences by age and gender through stratification. Time-to-onset (TTO) analysis was performed to investigate the factors affecting the onset of HPRL. Disproportionality analyses identified 39 drugs related to HPRL across six main anatomical systems, with the majority (N = 29) affecting the nervous system. Notably, most of these medications belong to psychotropic categories, including atypical antipsychotics (AAPs, N = 13), typical antipsychotics (TAPs, N = 5) and selective serotonin reuptake inhibitors (SSRIs, N = 5). Sensitivity analysis indicated that most signals remained robust, with risperidone exhibiting the strongest signal for HPRL, followed by amisulpride, paliperidone, fluphenazine, and thioridazine. Stratified analysis showed that females had stronger signals for HPRL. Compared to individuals aged 18-44, those aged ≥45 exhibited weaker signals, while the signals in minors varied by drug. TTO analysis revealed that AAP-related HPRL manifested earlier in females, with earlier onset observed in minors using AAPs or SSRIs. In conclusion, we identified and ranked drugs associated with HPRL, primarily psychotropic medications, and observed variations in signal strength and onset time across gender and age. These findings emphasize the importance of individualized HPRL screening based on specific medications, gender, and age.

Optimizing Therapeutic Drug Monitoring of Anti-infectives: Patient and Clinical Setting Considerations

Therapeutic drug monitoring (TDM) plays an essential role in personalized medicine, especially for anti-infective agents, due to the high global burden of infection-related morbidity and mortality. Achieving optimal therapy for antibacterial, antifungal, antiviral, and antimycobacterial agents can be challenging due to significant variability in pharmacokinetics/pharmacodynamics among different patients. This review explores the implementation of TDM and patient-related challenges using different anti-infective agents as examples across different clinical settings. TDM enables the implementation of a precision medicine approach, tailoring drug dosing to individual patient characteristics, disease states, and treatment variables.

The Role of Nutraceuticals and Functional Foods in Mitigating Cellular Senescence and Its Related Aspects: A Key Strategy for Delaying or Preventing Aging and Neurodegenerative Disorders

As life expectancy continues to increase, it becomes increasingly important to extend healthspan by targeting mechanisms associated with aging. Cellular senescence is recognized as a significant contributor to aging and neurodegenerative disorders. This review examines the emerging role of nutraceuticals and functional foods as potential modulators of cellular senescence, which may, in turn, influence the development of neurodegenerative diseases. An analysis of experimental studies indicates that bioactive compounds, including polyphenols, vitamins, and spices, possess substantial antioxidants, anti-inflammatory and epigenetic properties. These nutritional senotherapeutic agents effectively scavenge reactive oxygen species, modulate gene expression, and decrease the secretion of senescence-associated secretory phenotype factors, minimizing cellular damage. Nutraceuticals can enhance mitochondrial function, reduce oxidative stress, and regulate inflammation, key factors in aging and diseases like Alzheimer's and Parkinson's. Furthermore, studies reveal that specific bioactive compounds can reduce senescence markers in cellular models, while others exhibit senostatic and senolytic properties, both directly and indirectly. Diets enriched with these nutraceuticals, such as the Mediterranean diet, have been correlated with improved brain health and the deceleration of aging. Despite these promising outcomes, direct evidence linking these compounds to reducing senescent cell numbers remains limited, highlighting the necessity for further inquiry. This review presents compelling arguments for the potential of nutraceuticals and functional foods to promote longevity and counteract neurodegeneration by exploring their molecular mechanisms. The emerging relationship between dietary bioactive compounds and cellular senescence sets the stage for future research to develop effective preventive and therapeutic strategies for age-related diseases.

The use of remimazolam versus propofol for anesthesia induction in video-assisted thoracoscopic surgery: study protocol for a multicenter randomized controlled trial

BACKGROUND

Intraoperative hypotension may result in a higher incidence of postoperative myocardial injury, acute kidney injury, and stroke. Notably, more than half of intraoperative hypotension cases occur immediately after induction of general anesthesia. Although intraoperative hypotension has multiple causes, post-induction hypotension is primarily due to the effects of anesthetic drugs. Propofol is the most widely used agent for anesthesia induction. However, propofol can induce hemodynamic instability, potentially leading to adverse postoperative outcomes. Remimazolam, a novel ultra-short-acting intravenous sedative-hypnotic, may promote stable hemodynamics. Studies have reported that remimazolam is associated with less hypotension compared to propofol. Therefore, this study aims to compare the hemodynamic effects of remimazolam and propofol during anesthesia induction in patients undergoing video-assisted thoracoscopic surgery.

METHODS

This is a prospective, multicenter randomized controlled trial. A total of 172 patients aged 45 to 65 years undergoing video-assisted thoracoscopic surgery will be randomly allocated to receive remimazolam or propofol during anesthetic induction. The primary outcome is the incidence of hypotension occurring within 20 min after anesthesia induction. Hypotension is defined as systolic blood pressure (SBP) of less than 90 mmHg, or a reduction of more than 30% in SBP from baseline, or the administration of vasoactive medication. Secondary outcomes include the rate of successful sedation, time to successful sedation, coughing during the induction period, postoperative delirium within 7 days after surgery, and postoperative in-hospital mortality.

DISCUSSION

To date, remimazolam has rarely been used for anesthesia induction in video-assisted thoracoscopic surgery. This study will provide important information on hemodynamic stability and anesthesia efficacy of remimazolam in this surgical setting.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2400085556. Registered on 12 th June 2024, http://www.chictr.org.cn/ .

Effect of age and sex on the urinary elimination of a single dose of mixed flavonoids: results from a single-arm intervention in healthy United Kingdom adults

BACKGROUND

Nutrition intervention trials demonstrate that increased flavonoid intake can have clinically meaningful impacts on disease outcomes/biomarkers; however, high variability in absorption and metabolism and large heterogeneity in biochemical and physiological responses are observed. The etiology of this variability is poorly understood.

OBJECTIVE

The objective of this study was to explore the relationships between sex, age, and microbiota speciation on mixed flavonoid elimination over 24 h.

METHODS

Healthy males and females (n = 163) prospectively recruited on the basis of age (18-30 y or 65-77 y) and sex consumed a standardized flavonoid-rich test meal providing 640-mg cocoa/chocolate flavan-3-ols, 340-mg citrus flavanones, and 390-mg blackberry anthocyanins. Urinary samples collected at baseline (-24 to 0 h), 0 to 3.5 h, >3.5 h to 7 h, and >7 to 24 h were analyzed for flavonoids and their metabolites by ultra-high-performance liquid chromatography-mass spectrometry (UPLC-MS/MS). Stool microbiome speciation was determined via Illumina sequencing. Linear mixed-effect models were used to assess differences in cumulative excretion across age and sex with time-by-group interaction taken as the principal analysis of effect.

RESULTS

There were no group (older females, older males, younger females, and younger males) differences in total 24 h urinary metabolite recovery, but there was a trend toward a higher rate of cumulative recovery in older males at 24 h {β [95% CI (confidence interval): -61.4; -107, -16.0 younger males compared with older males; P-group at 24h = 0.06]}. Of 76 metabolites, 20 had significantly different times of maximum urine excretion (Tmax) by age and 9 by sex, with a later mean Tmax observed for older participants (92% of instances). Associations with age were not mediated by body mass index (BMI) or microbiome speciation. Significant differences in maximum urine excretion (Cmax) by sex were observed for only 6 metabolites and differences by age for 5 metabolites.

CONCLUSION

Total elimination recovery of (poly)phenols was relatively consistent across age and sex groups, whereas elimination kinetics differed substantially, possibly resulting from differences in intestinal transit time or kidney clearance. Assuming (poly)phenol metabolites have varying biological activities, establishing dose-response relationships and defining metabolite profiles in population subgroups is required to inform the future development of dietary flavonoid/(poly)phenol recommendations. This trial was registered at clinicaltrials.gov as NCT01922869.

Identification and Initial Resuscitation of Critically Unwell Older Patients in the Emergency Department

Identifying and managing critically unwell older patients in emergency departments are challenging for all clinicians. Physiologic changes, multiple comorbidities, and medications often mask or confound serious conditions in older people, and vital signs can be misleading. Because standard triage methods may be inadequate for this population, enhanced triage systems that incorporate frailty assessments and tailored scoring systems are useful. Serial assessments tailored to the patient, biomarkers, and advanced imaging are also important to better detect and manage critical illness in older adults and improve outcomes. Here, the authors discuss diagnosis and management of critically ill older adults.

Impact of a Geriatric Medication Safety Initiative (GEMSI) Pharmacist-Driven Procedure on Opioid Use in a Transitional Care Unit

Background: Millions of older people are hospitalized each year, and they often use pain medications during their stay. At the same time, about seven million people 65 years of age and older have filled at least one opioid prescription. Studies have found pharmacist-led interventions to minimize inappropriate prescribing and optimize medication regimens. These also may reduce adverse events and length of stay. Objective A pharmacist-driven procedure, the Geriatric Medication Safety Initiative (GEMSI), was created in May 2017. The primary outcome of this study was to examine the opioid morphine milligram equivalent per day (MMED) pre- and post-implementation of GEMSI. Secondary outcomes included length of stay (LOS) and acetaminophen use per day. Design This was a retrospective, single-center cohort study with pre- and post-implementation groups. Data were extracted via chart review to determine the reason for admission, length of stay, non-opioid pain medication usage, and MMED. Data are expressed as mean, standard deviation (SD), and n (%). Chi square, Mann Whitney U, and two sample t-tests were performed as appropriate. Setting A transitional care unit (TCU) in the state of New York that has achieved an Institute for Healthcare Improvement (IHI) for Age-Friendly health level 2 center designation. It is a short-term (usual maximum of 21 days) rehabilitation and acute care setting. Patients who are medically stable after their acute admission but need additional physical and/or occupational therapy are eligible for admission. Patients, Participants Patients greater than or equal to 65 years of age admitted to the TCU in 2016 or 2018 were included. Patients were excluded if they were acutely ill and/or transferred off the TCU. Intervention This was a single-center (ie, a short-term inpatient rehabilitation facility), retrospective, cohort chart review study that was exempted from Institutional Review Board (IRB) review. Results In total, 566 patients were included. The overall mean MMEDs pre- and post-GEMSI were 9.5 (+/- 18.0) compared to 8.5 (+/- 22.7) mg/day, respectively (P = 0.186). The TCU length of stay decreased from a mean of 12.4 to 11.1 days (P = 0.005) and the average acetaminophen use increased from 673 to 722 mg/day from pre- to post-GEMSI (P < 0.001). Lidocaine doses utilized per day were not statistically different between pre- to post-GEMSI (0.14 doses per day vs 0.20 doses per day; P = 0.798). In a subgroup analysis of patients who reported pain, the mean MMEDs were 15.3 (+/- 21.3) compared to 10.9 (+/- 18.7) mg/day, respectively (P = 0.038). Discussion This retrospective study demonstrates that the implementation of a pharmacist-driven procedure, such as GEMSI, is associated with decreased opioid exposure and increased use of non-opioid analgesics such as acetaminophen. By decreasing the exposure to opioid medications, we expect that patients are less likely to experience dose-dependent adverse effects of opioids. Conclusion A pharmacist-driven procedure for multimodal pain management was associated with a decreased MMED and reduced LOS. Future large-scale studies need to be conducted to replicate these results in different practice settings.

Shaping the future of geriatric chronic pain care: a research agenda for progress

Chronic pain is highly prevalent among older adults and its burden will become increasingly significant as our population ages. Yet, chronic pain is often undertreated in this vulnerable population due to various barriers in health care delivery. To improve geriatric chronic pain management, we assert that older adults require a dedicated research agenda designed to inform the development, testing, and implementation of chronic pain treatments that account for the unique vulnerabilities and healthcare needs of this population. Specifically, we propose that the following four areas of research require immediate attention to better serve older adults with chronic pain: (1) health equity, (2) substance use, (3) dyadic interventions, and (4) digital health. Our proposed research agenda aims to create a more robust and comprehensive body of evidence that will ultimately transform and advance geriatric chronic pain management.

Variability in Meropenem Distribution and Clearance in Children with Sepsis: Population-Based Pharmacokinetics with Assessment of Renal Biomarkers

BACKGROUND AND OBJECTIVE

Meropenem dosing to achieve therapeutic exposure in critically ill children with sepsis is challenging due to a spectrum of renal function, from augmented renal clearance (ARC) to acute kidney injury (AKI). The objective of this study was to define meropenem plasma concentrations and pharmacodynamic exposure metrics in children with septic shock during the first 3 days of PICU hospitalization.

METHODS

We prospectively evaluated meropenem clearance (CLMERO) and volume of distribution (V1-MERO), innovatively assessing renal biomarkers (serum creatinine [SCr], serum cystatin C [SCys], and neutrophil gelatinase-associated lipocalin [SNgal]), in infants aged ≥ 4 weeks and children on intravenous (IV) meropenem 20 mg/kg every 8 h from 2019 to 2023. Cases with sepsis were matched to controls without sepsis.

RESULTS

Analysis included 27 participants (19 cases and 8 controls) with 309 meropenem serum concentrations. Median age was 11.8 (range 0.6-19.6) years, weight 36.3 (7.2-98.0) kg, SCr 0.33 (0.09-2.57) mg/dL, SCys 451.1 (178.3-1824.1) ng/mL, and SNgal 180.7 (23.2-1403.0) ng/mL. A 2-compartment, population pharmacokinetic (PK) model via NONMEM best described data, with weight on VMERO and allometric scaling on CLMERO. Using the final model with SCys in V1-MERO and estimated glomerular filtration rate (eGFR)-MS in CLMERO, the median V1-MERO was 0.23 (range 0.07-0.57) L/kg and CLMERO 0.15 (0.05-0.49) L/h/kg, with eGFR-MS 139 (23-365) mL/min/1.73 m2 from AKI to ARC. Meropenem clearance, V1-MERO and eGFR-MS were significantly decreased in cases versus controls, with higher variability of eGFR-MS in cases.

CONCLUSION

Wide variation in meropenem concentrations in children with sepsis as compared to those without sepsis prompt close monitoring of GFR and drug concentrations in this population.

Antipsychotics and dietary interventions: Pharmacodynamics, pharmacokinetics, and synergisms in therapy

Antipsychotic (AP) medications are the primary treatment for severe mental illnesses, including schizophrenia and severe mood disorders. APs are currently categorized into typical or first-generation APs and atypical or second-generation APs. Although both first-generation and second-generation APs are considered effective in treating psychotic symptoms in severe mental disorders, they differ in their mechanisms, treatment strategies, and side effect profiles. Because of their potential motor and metabolic side effects, which often compromise patient adherence and clinical outcomes, whether and how to use APs remains controversial. The use of dietary interventions in combination with APs is emerging as a viable strategy to reduce AP adverse effects while maintaining their efficacy and enhance patient adherence to treatment. In contrast to drugs that possess a well defined molecular mechanism of action, dietary interventions act in pleiotropic ways by nature. While providing a holistic approach to patient care this pleiotropy needs to be analyzed and systematized to enhance the efficacy and safety of the combination of them with APs. Guidelines for this type of treatment are still needed. In this review, we explore the pharmacological properties, therapeutic applications, and limitations of APs, and discuss the potential benefits and limitations of those dietary interventions that are employed to improve the efficacy and counteract side effects of APs discussing also their mechanisms of action. Finally, we critically discuss the main results of clinical studies combining APs and dietary interventions and provide a view on future directions in terms of research and clinical use of these combinations. SIGNIFICANCE STATEMENT: Antipsychotic drugs are useful in a variety of psychiatric conditions, yet their use is hampered by issues of efficacy and safety. An important step toward therapy optimization is their use in combination with dietary interventions (ie, dietary supplements and nutraceuticals) that have shown promising results in clinical trials.

Association of remimazolam with delirium and cognitive function in elderly patients undergoing general anesthesia or procedural sedation: a meta-analysis of randomized controlled trials

Background

Remimazolam is an ultra-short-acting benzodiazepine with sedative effects, but its impact on postoperative delirium (POD) and cognitive function in elderly patients remains unclear. This study aimed to compare the incidence of POD and cognitive function between remimazolam and other sedatives in elderly patients undergoing general anesthesia or procedural sedation.

Methods

This study included randomized controlled trials (RCTs) comparing remimazolam with other sedatives in elderly patients undergoing general anesthesia or procedural sedation. A comprehensive search was conducted in Ovid MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and the China National Knowledge Infrastructure (CNKI) from inception to January 2, 2025, without language restrictions. Data were pooled quantitatively using a random-effects model. The primary outcomes were the incidence of POD and cognitive function.

Results

A total of 1,808 elderly patients from 11 RCTs were included. Compared with other sedatives, remimazolam did not increase the incidence of POD (OR: 0.62, 95% CI [0.23, 1.68], p = 0.35, I 2 = 73%), but improve cognitive function, as measured by Mini-Mental State Examination scores, the seventh postoperative day (MD: 0.53, 95% CI [0.16, 0.91], p = 0.005, I 2 = 28). Additionally, remimazolam significantly reduced the incidence of hypotension (OR: 0.27, 95% CI [0.21, 0.35], p < 0.001, I 2 = 0%) and respiratory depression (OR: 0.35, 95% CI [0.17, 0.69], p = 0.003, I 2 = 0%) compared to other sedatives. However, no significant differences were observed between remimazolam and other sedatives for postoperative nausea and vomiting (OR: 1.31, 95% CI [0.91, 1.89], p = 0.15, I 2 = 0%) or hypoxemia (OR: 0.69, 95% CI [0.35, 1.34], p = 0.28, I2 = 0%).

Conclusion

Overall, the use of remimazolam in the elderly population appears to pose fewer risks than other sedatives. It does not increase the incidence of postoperative delirium following general anesthesia or sedation, but it improves postoperative cognitive function and provides more stable hemodynamics. However, further well-designed RCTs with long-term follow-up are needed to establish a standardized medication regimen and optimal dosage tailored to elderly patients.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/myprospero, registration number (CRD4202563620).

Polypharmacy and Mild Cognitive Impairment in Older Adults: A 3-year Study of DO-HEALTH

OBJECTIVE

To examine the association between polypharmacy and mild cognitive impairment (MCI) at baseline and over 3 years in community-dwelling older adults.

DESIGN

Observational analysis of the DO-HEALTH trial.

SETTING AND PARTICIPANTS

Community-dwelling adults aged ≥70 years with good cognitive function and without major diseases at baseline.

METHODS

Main exposure was polypharmacy at baseline (≥5 medications). The outcome was MCI (Montreal Cognitive Assessment [MoCA] score <26), assessed at baseline and years 1, 2, and 3. Logistic regression and generalized estimating equations (GEEs) for repeated binary outcomes were used for the cross-sectional and longitudinal analysis, respectively. Minimally adjusted models included age, sex, prior fall, study site, body mass index, and education. Fully adjusted models additionally adjusted for mental health and multimorbidity. GEE models also accounted for time and DO-HEALTH treatment effects. Sensitivity analysis used a stricter MCI definition (MoCA < 24).

RESULTS

A total of 2153 participants completed MoCA at baseline. Baseline MCI prevalence was higher in participants with polypharmacy compared with those with no polypharmacy (MCI < 26: 53.5% vs 46.5%; MCI < 24: 34.9% vs 17.2%). Polypharmacy was associated with greater MCI odds at baseline in the minimally adjusted models (MoCA < 26: odds ratio [OR], 1.32; 95% CI, 1.05-1.66; MoCA < 24: OR, 1.37; 95% CI, 1.06-1.79). Over 3 years, polypharmacy was associated with increased MCI odds in the minimally adjusted models (MoCA < 26: OR, 1.28; 95% CI, 1.08-1.52; MoCA < 24: OR, 1.33; 95% CI, 1.07-1.65). Notably, these associations were somewhat attenuated and nonsignificant after controlling for mental health and multimorbidity.

CONCLUSION AND IMPLICATIONS

Our findings suggest that MCI is more prevalent in older adults with polypharmacy compared with those without polypharmacy. Although polypharmacy was associated with MCI at baseline and over 3 years, these associations were attenuated by mental health and multimorbidity, suggesting that mental health and multimorbidity contribute to both polypharmacy and MCI.

Advancing care: optimizing osteoporosis treatment in the older and oldest old population

Osteoporosis is a critical public health issue, particularly in the "older" (those aged over 75) and "oldest old" population (those aged 85 and above), who are at a heightened risk for fractures and related complications. This article reviews current osteoporosis treatments tailored for these age groups, emphasizing the balance between efficacy and safety, while considering cost/benefit aspects. We discuss pharmacological therapies available nowadays and their respective benefits and risks in the old population, based on the available literature on the subject. Special attention is given to specific features of this age category, like challenges of polypharmacy, physiological changes associated with age, comorbidities and patient adherence. This paper highlights the need for individualised treatment plans that consider the patient's overall health status, life expectancy and quality of life and the importance of continued innovation and personalized care in managing osteoporosis especially among the "older" population.

Activity of GPCR-targeted drugs influenced by human gut microbiota metabolism

Microbiota-mediated drug metabolism can affect pharmacological efficacy. Here we conducted a systematic comparative metabolomics investigation of drug metabolism modes by evaluating the impacts of human gut commensal bacteria on 127 G-protein-coupled receptor (GPCR)-targeted drugs. For the most extensively metabolized drugs in our screen, we elucidated both conventional and unconventional drug transformations and the corresponding activities of generated metabolites. Comparisons of drug metabolism by a gut microbial community versus individual species revealed both taxon intrinsic and collaborative processes that influenced the activity of the metabolized drugs against target GPCRs. We also observed iloperidone inactivation by generating unconventional metabolites. The human gut commensal bacteria mixture incorporated sulfur in the form of a thiophene motif, whereas Morganella morganii used a cascade reaction to incorporate amino-acid-derived tricyclic systems into the drug metabolites. Our results reveal a broad impact of human gut commensal bacteria on GPCR-targeted drug structures and activities through diverse microbiota-mediated biotransformations.

Serum Concentration of Antidepressant Drugs in Geriatric Day Care Patients With Renal Insufficiency and Multimorbidity

BACKGROUND

Geriatric depression is challenging to treat owing to age-related changes in pharmacokinetics and comorbidities. Although renal insufficiency and multimorbidity are typical geriatric complications that cannot be completely separated from each other, no study has examined the influence of these factors on the serum concentrations of antidepressants. For the first time, we evaluated the effects of these factors in combination on the dose-corrected serum concentration (C/D) of antidepressants in geriatric patients.

METHODS

In this retrospective study, data from 123 geriatric patients in a gerontopsychiatric day care unit at the University Hospital of Würzburg were analyzed. Multiple linear regression analysis and analysis of variance with confounders were used to examine the associations between glomerular filtration rate (GFR) and stages of renal impairment and the C/D of venlafaxine, mirtazapine, sertraline, and escitalopram corrected for multimorbidity, sex, lithium intake, and the number of triple whammy drugs.

RESULTS

GFR ( P < 0.001, ß = -0.070) was associated with the C/D of the active moiety of venlafaxine (N = 32). GFR, multimorbidity, and sex were not associated with the C/D of mirtazapine, escitalopram, or sertraline.

CONCLUSIONS

As the influence of sex may be less pronounced than that of decreasing GFR in terms of the C/D of the active moiety of venlafaxine in geriatric patients, we recommend considering the GFR for dose adjustment rather than sex. In conclusion, even in patients with mild renal impairment, serum venlafaxine concentration should be monitored to prevent overdosing. Mirtazapine, sertraline, and escitalopram may be well-suited antidepressants for geriatric patients with renal function impairment stage 2-3 as well as multimorbidity.

A Randomized Open-Label, Observational Study of the Novel Ketone Ester, Bis Octanoyl (R)-1,3-Butanediol, and Its Acute Effect on ß-Hydroxybutyrate and Glucose Concentrations in Healthy Older Adults

Bis-octanoyl-(R)-1,3-butanediol (BO-BD) is a novel ketone ester (KE) ingredient which increases blood beta-hydroxybutyrate (BHB) concentration rapidly after ingestion. KE is hypothesized to improve function in older adults. Whilst many studies have investigated KE in young adults, they have not been studied in healthy older adults (HOA), for whom age-related differences in metabolism may alter the effects. This randomized, observational, open-label study in HOA (n = 30, 50% male, age = 76.5y) aimed to elucidate tolerance, blood BHB and glucose concentrations for 4h following consumption of either 12.5 or 25 g of BO-BD formulated in ready-to-drink beverage (n = 30), and re-constituted powder (n = 21) with a meal. All study interventions were well tolerated, and increased blood BHB, inducing nutritional ketosis (≥0.5 mM) until the end of the study. Peak BHB concentration (Cmax) and incremental area under the curve (iAUC) were significantly greater with 25 vs 12.5 g of BO-BD in both formulations. There were no significant differences in Cmax or iAUC between formulations. Blood glucose increased in all conditions following the meal, with no consistent significant differences between conditions. These results demonstrate that both powder and beverage formulations of the KE, BO-BD, induce ketosis in HOA adults, facilitating future research on functional effects of KE in aging.

Variability in Response to Valsartan and Its Relationship With AGT M235T Genotype and Other Nongenetic Parameters Among a Sample of Hypertensive Individuals in Jordan: A Prospective Pilot Study

Background

Valsartan, an angiotensin receptor antagonist widely used in hypertension and heart failure management, exhibits noticeable interindividual variation in response among hypertensive patients at the University of Jordan Hospital. The angiotensinogen (AGT) gene variant M235T, a functional genetic variant, influences the renin-angiotensin system.

Aims

This study aims to explore interindividual variations in the valsartan response, considering genetics, particularly the AGT M235T variant, and other nongenetic factors.

Methods

This cohort study involved 95 unrelated Arabic Jordanians diagnosed with essential hypertension. Systolic (SBP) and diastolic blood pressure (DBP) measurements were taken at the initiation of 160 mg valsartan and after 1 month of treatment, assessing the valsartan response for each patient. Genetic analysis of AGT M235T was done using the polymerase chain reaction-restriction fragment length polymorphism genotyping method. Anthropometric data were collected from University of Jordan Hospital computer records.

Results

Valsartan response assessment revealed diverse individual responses, the response to valsartan varied, with SBP reductions from < 10 to > 70 mmHg and DBP from < 2 to 30 mmHg. Patients with homozygous AGT M235T genotypes showed a less significant response (p < 0.05) to valsartan than heterozygous and reference genotypes. Additionally, results indicated a positive correlation of age (p = 0.03) and a negative correlation of height (p = 0.02-0.04) with the valsartan response. Regression analysis demonstrated that the patients' sex significantly influenced the valsartan response (p < 0.05).

Conclusions

This study identifies the AGT M235T genotype as a potential genetic contributor to variability in the valsartan response. Associations with age, height, and sex underscore the importance of considering genetic and demographic factors in tailoring valsartan therapy, for advancing personalized hypertension management.

PBPK models of the female reproductive tract: current and future analysis

INTRODUCTION

Drug delivery via the female reproductive tract (FRT) has garnered increasing attention due to its potential for local and systemic therapies. Physiologically Based Pharmacokinetic (PBPK) models offer a mechanistic approach to understanding drug absorption, distribution, metabolism, and excretion (ADME) within the FRT, which is critical for optimizing treatments for conditions such as vaginal infections, contraception, and hormonal therapies.

AREAS COVERED

This review provides a comprehensive analysis of the current state of PBPK modeling for the FRT, focusing on its physiological and anatomical complexities. The paper reviews existing FRT PBPK models and discusses the challenges of simulating drug permeation and ADME processes in reproductive tissues. Data gaps, including tissue-specific physiological parameters and drug permeability, are identified. Methodological advances and biological factors influencing drug disposition in the FRT are explored, including hormonal cycles, interindividual variability, and disease states like polycystic ovary syndrome.

EXPERT OPINION

PBPK models for the FRT hold significant promise for improving drug delivery and therapy personalization. However, current limitations in data availability and model validation must be addressed. Future research integrating real-world patient data, advanced imaging techniques, and pharmacodynamic modeling will enhance these models' accuracy and clinical utility, advancing drug development and regulatory processes.

Does nutritional support prevent severe mucositis in patients with head and neck cancer treated with chemoradiotherapy? A systematic review and meta-analysis

BACKGROUND

For patients with advanced head and neck cancer (HNC) chemoradiotherapy (CHRT) is the main treatment option. CHRT is a severe treatment with a high ratio of side effects which may be even more pronounced due to mucosities related malnutrition. Nutritional intervention like nutritional counseling (NC) and oral nutritional supplements (ONS) may prevent malnutrition. A systematic review and meta-analysis was performed to assess the effect of NC with or without ONS (NC±ONS) on CHRT-related grade ≥3 mucositis in patients with HNC undergoing CHRT.

METHODS

PubMed/MEDLINE, Web of Science, and Scopus were searched to identify randomized and non-randomized clinical studies of HNC patients undergoing CHRT, where mucositis grade ≥3 data were provided. Comparative and proportional meta-analyses were performed to calculate the odds ratio (OR) and incidence of a mucositis grade ≥3 in the included studies (%) with 95% confidence intervals (95% CI).

RESULTS

There were seven studies fulfilling inclusion criteria with 655 participants included. NC±ONS revealed no risk reduction of grade ≥3 mucositis (OR: 1.2, 95%CI: 0.7-1.9). The overall mucositis rate was 38.3% (95% CI: 24.8%-52.6%) and 32.8% (95% CI: 14.9%-53.5%) (P = 0.67) in NC+ONS and NC-ONS respectively.

CONCLUSION

Despite the undeniable role of NC±ONS for patients with HNC undergoing CHRT, we found it insufficient to avoid grade ≥3 CHRT-related mucositis. Further research should be conducted to determine recomendations how to decrease the risk of oral mucosities and, in consequence, how to prevent malnutrition in patients with CHRT.

Analysis of Personalized Cardiovascular Drug Therapy: From Monitoring Technologies to Data Integration and Future Perspectives

Cardiovascular diseases have long been a major challenge to human health, and the treatment differences caused by individual variability remain unresolved. In recent years, personalized cardiovascular drug therapy has attracted widespread attention. This paper reviews the strategies for achieving personalized cardiovascular drug therapy through traditional dynamic monitoring and multidimensional data integration and analysis. It focuses on key technologies for dynamic monitoring, dynamic monitoring based on individual differences, and multidimensional data integration and analysis. By systematically reviewing the relevant literature, the main challenges in current research and the proposed potential directions for future studies were summarized.

Analgesic effect of ropivacaine combined with methylene blue in fascia Iliaca block for patients undergoing hip arthroplasty

BACKGROUND

The duration of a single fascia iliaca compartment block (FICB) with ropivacaine is limited. This study investigated whether methylene blue as an adjuvant anesthetic in FICB can enhance the postoperative analgesic effect following total hip arthroplasty (THA).

METHODS

Patients who planned to undergo THA were recruited for this randomized clinical trial from June 2023 to February 2024. Ninety elderly patients undergoing THA were randomly divided into two groups that received ultrasound-guided FICB with either ropivacaine and methylene blue (MB + R group, n = 45) or ropivacaine only (R group, n = 45) before induction of general anesthesia. The primary outcomes were postoperative Visual Analog Scale (VAS) scores. Secondary outcomes included inflammatory factor levels, heart rate (HR), mean arterial pressure (MAP), postoperative analgesic use, postoperative activity, and adverse events.

RESULTS

The MB + R group had significantly lower VAS scores at both rest and with activity at 24 and 48 h postoperatively than the R group (P < 0.001). Additionally, the hypersensitive C-reactive protein, procalcitonin, and neutrophil-to-lymphocyte ratio values were significantly lower in the MB + R group than in the R group on the first and second days after surgery (P < 0.05). The number of patients requiring supplemental analgesia postoperatively was significantly lower in the MB + R group (P = 0.020). Additionally, the MB + R group had a significantly longer walking distance on the first time out of bed and a higher number of out-of-bed activities within 48 h postoperatively (P < 0.001).

CONCLUSION

Compared to ropivacaine alone, the combination of ropivacaine and methylene blue in FICB provided better analgesic effects over a longer duration. Additionally, the addition of methylene blue reduced the postoperative production of inflammatory markers and promoted patients' functional recovery.

TRIAL REGISTRATION

ClinicalTrials.gov, Registration number: NCT06284941, Retrospectively registered, Date of registration: February 04, 2024.

Safety Profile and Hepatotoxicity of Anaplastic Lymphoma Kinase Tyrosine Kinase Inhibitors: A Disproportionality Analysis Based on FDA Adverse Event Reporting System Database

Anaplastic lymphoma kinase tyrosine kinase inhibitors (ALK-TKIs) have become first-line therapies for advanced non-small cell lung cancer (NSCLC) with ALK rearrangements. This study investigates ALK-TKI-associated adverse events (AEs), focusing on identifying hepatotoxicity signals and previously undocumented safety concerns. Using disproportionality analysis of 56,864 reports from the FDA Adverse Event Reporting System (FAERS) database, we systematically classified AEs via the Medical Dictionary for Regulatory Activities (MedDRA). At the System Organ Class (SOC) level, crizotinib exhibited a significantly stronger signal for eye disorders, ceritinib was uniquely linked to gastrointestinal disorders, and loratinib was predominantly associated with metabolism and nutrition disorders. Several AEs previously undocumented in drug labels were identified, including pericardial effusion, elevated C-reactive protein, hemolytic anemia, hemoptysis, and decreased hemoglobin. Furthermore, crizotinib, ceritinib, and alectinib were significantly associated with hepatotoxicity, marked by elevated alanine aminotransferase, aspartate aminotransferase, and hepatic enzyme levels. These findings highlight the need for vigilant monitoring of unlabeled AEs and potential label updates, particularly for hepatotoxicity risks associated with crizotinib, ceritinib, and alectinib.

Real-world safety profile of elexacaftor/tezacaftor/ivacaftor: a disproportionality analysis using the U.S. FDA adverse event reporting system

Background

Elexacaftor/Tezacaftor/Ivacaftor (ETI) has demonstrated significant efficacy in enhancing clinical outcomes for patients with cystic fibrosis (CF). Despite this, comprehensive post-marketing assessments of its adverse drug events (ADEs) remain insufficient. This study aims to analyze the ADEs associated with ETI using the U.S. FDA Adverse Event Reporting System (FAERS).

Methods

We conducted a pharmacovigilance analysis utilizing FAERS data from Q4 2019 to Q3 2024. Reports of ADEs related to ETI were extracted, and disproportionality analyses-including Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Multi-item Gamma Poisson Shrinker (MGPS)-were employed to evaluate signal strength. Additionally, a time-to-onset (TTO) analysis was performed.

Results

A total of 28,366 ETI-related ADEs were identified, spanning 27 organ systems. We identified 322 positive signals, with signals consistent with the drug label including headache (702 cases, ROR 2.75), infective pulmonary exacerbation of CF (691 cases, ROR 384.24), rash (538 cases, ROR 2.72), and cough (507 cases, ROR 3.79). Unexpected signals were also noted, such as anxiety (494 cases, ROR 4.16), depression (364 cases, ROR 4.59), insomnia (281 cases ROR 2.83), nephrolithiasis (79 cases, ROR 3.63) and perinatal depression (4 cases, ROR 13.59). The TTO analysis indicated that the median onset of ADEs was 70 days, with 37.08% occurring within the first month. Subgroup analyses revealed that females exhibited a higher reporting rank for mental disorder and constipation, whereas in males, they were insomnia, abdominal pain, and nasopharyngitis.

Conclusion

This study highlights both recognized and unexpected ADEs associated with ETI, underscoring the necessity for ongoing monitoring, particularly concerning psychiatric conditions. The subgroup analysis suggests a need for personalized treatment strategies to optimize patient care.

Exploring the potential of mucoadhesive buccal films in geriatric medicine

As the global demographic shifts toward an aging society, the geriatric patient population is steadily increasing. These patients often suffer from comorbidities and require numerous oral medications, which can be especially challenging for dysphagic geriatric patients. Mucoadhesive buccal films (MBFs) seem promising and could reduce pill burden, simplify administration, and enable individualized drug therapy. This review aims to explore the age-related changes in the oral cavity and their impact on MBF delivery, including potential strategies to overcome these age-related barriers to drug delivery. It was observed that aging impacts the oral mucosa as well the properties of the saliva. There are several studies in the application of buccal films including the use of a wide range of permeation enhancers. The 3D printing of buccal films seems to introduce dosing flexibility to buccal film manufacturing.

Missed opportunities: the detection and management of at-risk drinking and illicit drug use in acutely hospitalized patients

At-risk alcohol and illicit drug use are risk factors for disease and in-hospital complications. This study investigated whether clinicians document substance use in the electronic records of acutely hospitalized internal medicine patients. Alcohol and illicit drug positive patients were identified using prospectively gathered substance use data from a study sample comprising 2,872 patients included from November 2016 to December 2017 at an internal medicine hospital in Oslo, Norway. These data were unknown to hospital staff. Whether physicians recorded quantitative substance use assessments and interventions was examined in patients with study-verified alcohol use in excess of low-risk guidelines (Alcohol Use Disorder Identification Test-4 scores [AUDIT-4] of ≥5 for women and ≥7 for men) and/or illicit drug use (one or more illicit drug detected by liquid chromatography-mass spectrometry [LC-MS] analysis). Among 548 study-verified alcohol-positive patients, physicians documented quantity and frequency (QF) of use in 43.2% (n = 237) and interventions in 22.0% (n = 121). Alcohol interventions were associated with harmful drinking (AUDIT-4 ≥9 points; adjusted odds ratio [AOR] = 4.87; 95% CI: 2.54-9.31; p < 0.001) and QF assessments (AOR = 3.66; 95% CI: 1.13-11.84; p = 0.02). Among 157 illicit-positive patients, drug use was described quantitatively in 34.4% (n = 54) and interventions in 26.0% (n = 40). The rate of quantitative alcohol and illicit drug use assessment by hospital physicians is poor, with a correspondingly low intervention rate. Important opportunities for attenuating or intervening in at-risk alcohol and illicit drug use are missed.

Prevalence and risk factors of self-reported adverse drug events in elderly co-morbid patients in northeastern China: a cross-sectional study

BACKGROUND

Older adults are vulnerable to adverse drug events given the pharmacokinetic and pharmacodynamic changes that coming with ageing, as well as they often take multiple medications for their chronic health conditions, especially older co-morbidities. ADEs can cause unnecessary emergency department visits and hospitalization, which contribute to financial burden and decreased quality of life. This study aims to investigate the prevalence of adverse drug events in elderly co-morbid patients in Liaoning province and explore its risk factors, in order to ensure medication safety in elderly patients.

METHODS

This was a cross-sectional study that enrolled elderly patients with co-morbidities, and the data were collected by nurses using a structured interview method for elderly patients with multimorbidity. Risk factors for patient-reported adverse drug events were identified by univariate and logistic regression analyses.

RESULTS

A total of 329 elderly patients were enrolled, among whom 169 were females, with an age ranging from 61 to 90 years. 205 participants (62.3%) had 462 "possible-probable-certain" adverse drug events, and 156 (47.4%) experienced two or more self-reported adverse drug events concurrently. The logistic regression analysis included four variables: female (OR = 2.194, 95% confidence interval 1.281-3.760, P = 0.004), numbers of daily drugs > 12 (OR = 2.257, 95% confidence interval 1.254-4.061, P = 0.007), history of fall within 1 year (OR = 3.106, 95% confidence interval 1.112-8.674, P = 0.031), and medication noncompliance (OR = 3.768, 95% confidence interval 1.535-9.249, P = 0.004).

CONCLUSION

Patient-reported adverse drug events are more prevalent in older co-morbid patients in Liaoning province. Female, numbers of daily drugs, fall history with 1 year and poor medication compliance were significantly and independently associated with adverse drug events. These findings may provide informative interventions for the medication management in elderly patients living with multimorbidity.

Potentially inappropriate medications use among the older patients diagnosed with psychiatric diseases in Saudi Arabia: a cross-sectional study

Objective

To examine the prevalence of potentially inappropriate medications (PIMs) prescribed among older patients diagnosed with psychiatric diseases and to identify associated factors.

Methods

This cross-sectional study was conducted among older patients who visited outpatient clinics in Saudi Arabia between June 1st, 2019, and May 31st, 2023. PIMs use was estimated using the updated 2019 American Geriatric Society (AGS) Beers criteria. Data were analyzed using chi-square or Fisher's exact test for categorical variables and t-test for continuous variables to compare patients with and without PIMs. In addition, the Pearson correlation test was performed between the total number of prescriptions and the number of PIMs. Multivariable logistic regression analysis was used to explore PIMs. Statistical significance was set at p < 0.05.

Results

Our study included 306 patients with psychiatric diseases, with 156 (50.98%) in the PIMs group and 150 (49.02%) in the non-PIMs group. There was a considerable positive correlation between the total number of prescriptions and the number of PIMs (r = 0.76; p < 0.0001). The adjusted logistic regression analysis revealed a significantly higher risk of PIMs use in individuals with psychiatric diseases and comorbid neurological diseases compared to those without [adjusted odds ratio (AOR) = 2.48, 95% CI [1.15-5.32]]. In contrast, the risk of PIMs use was not significantly greater for older individuals with psychiatric diseases and comorbid hypertension {AOR = 1.67, 95% CI [(0.79-3.54)]}, diabetes mellitus {AOR = 1.25, 95% CI [(0.66-2.34)]}, or pulmonary disease {AOR = 2.34, 95% CI [(0.69-7.96)]}.

Conclusion

This study highlighted the elevated number of PIMs in older adults with psychiatric diseases in the outpatient setting, particularly those with comorbid neurological diseases. Therefore, clinical pharmacists may play a crucial role in improving the outcomes of patients diagnosed with psychiatric illnesses. Finally, future studies should examine additional strategies to reduce the use of PIMs in this population.

Patient Characteristics and Treatment Outcomes of Nasopharyngeal Carcinoma in Nonendemic Regions

Importance

Nasopharyngeal carcinoma (NPC) presents unique challenges in nonendemic regions, with varying patient characteristics and outcomes compared with endemic populations.

Objective

To fill gaps in the current understanding of NPC by focusing on a US population, comparing patient characteristics and treatment outcomes with endemic populations, and identifying key factors to inform management and follow-up protocols in Western health care settings.

Design, Setting, and Participants

This retrospective cohort study included patients with NPC treated at a single large US tertiary academic medical center from 2000 to 2023. The study analyzed patient demographics, tumor characteristics, treatment modalities, and survival outcomes. Data were analyzed from January to July 2024.

Main Outcomes and Measures

Overall survival (OS), progression-free survival (PFS), and recurrence-free survival, stratified by patient characteristics, tumor types, Epstein-Barr virus (EBV) status, and p16 expression.

Results

The sample included 159 adult patients with NPC (median [range] age, 53.5 [18-90] years; 117 [73.6%] male), with 23 African American patients (15.3%), 21 Asian patients (14.0%), and 106 White patients (70.7%). World Health Organization type III tumors predominated (88 patients [68.8%]), followed by type II (25 patients [19.5%]) and type I (15 patients [11.7%]). EBV positivity rates varied significantly by race (Asian: 13 patients [81.3%]; African American: 17 patients [63.0%]; White: 40 patients [47.0%]; P = .03) and WHO type (type III: 50 patients [72.5%]; type II: 10 patients [48.0%]; type I: 0 patients; P < .001). p16 status, a proxy for human papillomavirus status, did not vary by race but did vary by histopathologies (type III: 12 patients [28.5%]; type II: 12 patients [63.0%]; type I: 3 patients [43.0%]; P = .04). On Kaplan-Meier curves, stratifying p16 by EBV status eliminated its assumed association with OS. Multivariate analysis revealed that increasing age (hazard ratio [HR] per 1-year increase, 1.03 [95% CI, 1.00-1.05]; P = .04) and former smoking status (HR, 2.29 [95% CI, 1.03-5.10]; P = .04) were associated with inferior OS, while WHO type III tumors were associated with better OS compared with type I (HR, 0.38 [95% CI, 0.17-0.87]; P = .02). Male sex was associated with worse PFS (HR, 5.35 [95% CI, 1.23-23.30]; P = .03). For recurrence-free survival, former smokers (HR, 25.24 [95% CI, 2.56-249.23]; P = .006), current smokers (HR, 44.97 [95% CI, 2.27-892.10]; P = .01), and patients with advanced stages (IVa/b) (HR, 261.34 [95% CI, 3.96-17 258.06]; P = .009) had significantly increased risk.

Conclusions and Relevance

This cohort study contributes to the evolving body of knowledge on NPC in nonendemic regions, finding a shift toward WHO type III tumors and underscoring the association of EBV status with survival outcomes, while highlighting the lack of association between human papillomavirus status and outcomes. Smoking history, advanced stage at diagnosis, male sex, and increasing age emerged as adverse factors. Notably, WHO type I tumors demonstrated particularly poor outcomes, highlighting the need for more intensive follow-up in this subgroup.

Adjuvant taxane-based chemotherapy treatment in older patients with early breast cancer: A pooled analysis of five phase III trials from the Hellenic Oncology Research Group

INTRODUCTION

The use of taxanes in the adjuvant setting of early breast cancer (BC) confers survival benefits, however, their role in older patients merits further study. This retrospective pooled analysis of randomized controlled trials conducted by the Hellenic Oncology Research Group (HORG) aims to assess the efficacy and safety of taxane-based adjuvant chemotherapy in older women with BC.

MATERIALS AND METHODS

Five phase III trials containing a taxane, conducted by HORG between 1995 and 2013, were included in a patient-data pooled analysis. The primary endpoint was disease-free survival (DFS) at three years, whereas secondary outcomes included overall survival (OS) at five years and toxicity.

RESULTS

A total of 3,026 randomized patients, of whom 701 (23 %) were ≥ 65 years old (median age 69 years; range 65-80), were included in the analysis. No statistically significant heterogeneity in survival was observed between older and younger patients. Within the cohort of older patients, taxane-based regimens were superior to 5-fluorouracil, epirubicin, and cyclophosphamide (FE75C) regimen in terms of three-year DFS (92.02 % vs 77.17 %; p < 0.001) and five-year OS (94.38 % vs 72.64 %; p < 0.001), respectively. A higher number of older patients discontinued treatment compared to younger patients (5.7 % vs 2.9 %; p < 0.001), mainly due to toxicity (3.4 % vs 1.8 %; p = 0.01). The incidence of grade 3-4 neutropenia (35.4 % vs 29.8 %; p = 0.006) and thrombocytopenia (0.8 % vs 0.3 %; p = 0.049) was higher for patients aged ≥65 years compared to those aged <65 years; however, there was no difference in terms of febrile neutropenia and non-hematologic toxicity.

DISCUSSION

Taxane-based adjuvant chemotherapy offers significant survival benefits in older patients with BC, similar to younger patients, yet with increased toxicity.

Preoperative Geriatric Characteristics Associated with Changes in Postoperative Cognitive Function and Quality of Life: A Prospective Observational Analytic Multicenter Study

BACKGROUND

Changes in cognitive function are associated with increased depression and decreased quality of life (QOL). This study aimed to determine the relationship between the characteristics of geriatric patients and anesthetic management with changes in postoperative cognitive function and QOL of geriatric patients undergoing elective surgery.

METHODS

This prospective observational analytic multicenter study included patients aged ≥60 years who underwent elective surgery in hospitals in Indonesia. We used the whole sampling method and performed follow-up 30 days after surgery. Data were analyzed using bivariate chi-square and multivariate regression tests with a confidence interval of 95% and α=5%.

RESULTS

Among the 933 geriatric patients included in this study 55.0%, females most (59.8%) received general anesthesia. Factors including age (p<0.001, B=-0.374, odds ratio [OR]=0.688), body mass index (BMI) (p<0.05, B=0.129, OR=1.138), and physical status based on American Society of Anesthesiologists (ASA) classification (p<0.001, B=-0.458, OR=0.633) were significantly associated with postoperative cognitive function. BMI (p<0.001, B=-0.218, OR=1.244), absence of comorbidities (p<0.05, B=-0.312, OR=0.732), regional anesthesia (p<0.05, B=0.606, OR=1.883), and changes in cognitive function (p<0.05, B=0.288, OR=1.334) were significantly correlated with changes in postoperative QOL.

CONCLUSION

Age, BMI, and ASA physical status were significantly associated with postoperative cognitive function in geriatric patients, whereas BMI, comorbidities, regional anesthesia, and changes in postoperative cognitive function were associated with QOL. These preoperative factors can predict postoperative cognitive function and QOL and may be useful during preoperative planning.

Exploring Manipulated Prescribed Medicines for Novel Leads in 3D Printed Personalized Dosage Forms

Background: On-demand personalized drug production is currently not addressed with large-scale drug manufacturing. In our study, we focused primarily on identifying possible active pharmaceutical ingredients (APIs) for 3D Printing (3DP) in the current healthcare setting. Methods: We conducted a retrospective cross-sectional study in the Netherlands using three different sources; community pharmacies (n = 5), elderly care homes (n = 3), and the Erasmus MC Sophia Children's Hospital. The primary endpoint was the percentage of prescriptions of medication manipulated before administration, thereby being a candidate for 3DP. Around a million prescriptions were analyzed in our study. Results: This study shows that around 3.0% of the prescribed drugs dispensed by Dutch community pharmacies were manipulated before administration, while around 10.5% of the prescribed drugs in the Erasmus MC Sophia Children's Hospital were manipulated prior to administration. Conclusions: With our study, we show that the most manipulated drugs come from the groups of constipation, psychopharmaceutical, cardiovascular, and anti-infectant drugs. Successful introduction of a compounded API drug by 3DP does not only rely on the API, but it also comes with an optimal balance between technical, economic as well as societal impact factors. Our study gives direction for potential future research on the introduction of 3DP of medicine in the healthcare setting.

Glial Cell Reprogramming in Ischemic Stroke: A Review of Recent Advancements and Translational Challenges

Ischemic stroke, the second leading cause of death worldwide and the leading cause of long-term disabilities, presents a significant global health challenge, particularly in aging populations where the risk and severity of cerebrovascular events are significantly increased. The aftermath of stroke involves neuronal loss in the infarct core and reactive astrocyte proliferation, disrupting the neurovascular unit, especially in aged brains. Restoring the balance between neurons and non-neuronal cells within the perilesional area is crucial for post-stroke recovery. The aged post-stroke brain mounts a fulminant proliferative astroglial response, leading to gliotic scarring that prevents neural regeneration. While countless therapeutic techniques have been attempted for decades with limited success, alternative strategies aim to transform inhibitory gliotic tissue into an environment conducive to neuronal regeneration and axonal growth through genetic conversion of astrocytes into neurons. This concept gained momentum following discoveries that in vivo direct lineage reprogramming in the adult mammalian brain is a feasible strategy for reprogramming non-neuronal cells into neurons, circumventing the need for cell transplantation. Recent advancements in glial cell reprogramming, including transcription factor-based methods with factors like NeuroD1, Ascl1, and Neurogenin2, as well as small molecule-induced reprogramming and chemical induction, show promise in converting glial cells into functional neurons. These approaches leverage the brain's intrinsic plasticity for neuronal replacement and circuit restoration. However, applying these genetic conversion therapies in the aged, post-stroke brain faces significant challenges, such as the hostile inflammatory environment and compromised regenerative capacity. There is a critical need for safe and efficient delivery methods, including viral and non-viral vectors, to ensure targeted and sustained expression of reprogramming factors. Moreover, addressing the translational gap between preclinical successes and clinical applications is essential, emphasizing the necessity for robust stroke models that replicate human pathophysiology. Ethical considerations and biosafety concerns are critically evaluated, particularly regarding the long-term effects and potential risks of genetic reprogramming. By integrating recent research findings, this comprehensive review provides an in-depth understanding of the current landscape and future prospects of genetic conversion therapy for ischemic stroke rehabilitation, highlighting the potential to enhance personalized stroke management and regenerative strategies through innovative approaches.

Data pharmacovigilance analysis of medroxyprogesterone-related adverse events in the FDA adverse event reporting system

OBJECTIVES

Medroxyprogesterone acetate (MPA), a steroid progesterone, is widely used to treat endometriosis, menstrual disorders, and uterine bleeding in clinical practice. However, the safety profile of MPA requires comprehensive evaluation.

METHODS

This study performed a retrospective analysis using real-world data extracted from the US Food and Drug Administration Adverse Event Reporting System (FAERS) database. Case reports from 2003 to 2023 were analyzed using methods like reporting advantage ratio (ROR), proportional report ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and empirical Bayes geometric mean (EBGM).

RESULTS

In the case reports spanning from 2003 to 2023, showed 26,437 adverse events (AEs) related to MPA, mostly in females (25,639). Disproportionality analysis identified 116 ADRs across 19 system organ class (SOC) levels, including expected AEs like 'female breast cancer'(n = 8717) and 'ovarian cancer' (n = 459). Unexpected AEs, such as 'acquired diaphragmatic eventration'(n = 3), were also noted.

CONCLUSION

Our study identifies potential new and unexpected ADR signals linked to MPA, which align with clinical observations. Additional research is necessary to confirm these associations and address previously unrecognized safety concerns. This research provides a novel and distinctive approach to exploring drug-related AEs.

Medication reviews in hospitalised patients for reduced hospital readmission and mortality. Systematic review, meta-analysis and meta-regression of RCTs

Efforts to reduce preventable medication-related harm through medication reviews have increased, but interventions often yield null-results regarding clinical outcomes. We conducted a systematic literature search in four data bases and summarised the available evidence from randomised controlled trials (RCTs) comparing medication reviews and usual care in hospitalised patients regarding hospital readmissions and all-cause mortality by random-effects meta-analyses. Effect size differences by methodological study differences were of special interest. The meta-analysis of all 24 trials on hospital readmissions, including 12,539 participants, showed a statistically significant 8 % decrease in hospital readmissions (risk ratio (RR) [95 % confidence interval]: (0.92 [0.88-0.97], p = 0.002). The number of patient contacts was the most prominent effect modifier in meta-regression (p = 0.003) and the effect of medication reviews was approximately twice as strong (15 %) in 11 trials with 2 or more patient contacts (0.85 [0.78-0.92], p < 0.001). No statistically significant reduction in all-cause mortality was observed in a meta-analysis of all 22 trials with data for this outcome (0.95 [0.86-1.04], p = 0.24), including 12,350 participants. The method of mortality assessment was identified as an effect modifier by meta-regression (p = 0.01). A meta-analysis of 10 trials with complete mortality ascertainment via registries or primary care data showed a significantly 19 % reduced mortality (0.81 [0.70-0.94], p < 0.01). In conclusion, medication reviews reduce the risk of hospital readmission and might also reduce all-cause mortality. Comprehensive mortality assessment was essential for successful trials. Clinical guidelines should recommend medication reviews with multiple patient contacts, involving pharmacists, either for repeated medication reviews or to improve adherence.

Population Pharmacokinetics of Meropenem Across the Adult Lifespan

BACKGROUND AND OBJECTIVE

We conducted an opportunistic pharmacokinetic study to evaluate the population pharmacokinetics of meropenem, an antimicrobial commonly used to treat Gram-negative infections in adults of different ages, including older adults, and determined optimal dosing regimens.

METHODS

A total of 99 patients were included. The population pharmacokinetic models used had two compartments: zero-order input and linear elimination. Covariates evaluated included renal function, body size, age, sex, vasopressor use, and frailty, using the Canadian Study of Health and Aging Clinical Frailty score (in patients aged ≥ 65 years). We simulated optimal dosing regimens by renal function and by age group to achieve therapeutic target attainment.

RESULTS

Participants' ages ranged from 20 to 95 years, with an average age of 57.4 years, and 22% (23/103) were aged ≥ 75 years. Creatinine clearance had the greatest impact on the clearance of meropenem. After accounting for renal function and body size, no other covariates resulted in a significant impact on the pharmacokinetics of meropenem. Simulations indicated that patients with normal renal function achieved ≥ 90% target attainment only for organisms with minimum inhibitory concentrations (MICs) ≤ 4 mg/L using the least strict surrogate target of unbound concentration > MIC (fT>MIC) for 40% of the dosing interval. For the conservative target fT>4xMIC for 100% of the dosing interval, extended infusion may be required even for organisms with MICs up to 0.25 mg/L. Patients with renal impairment could achieve ≥ 90% target attainment for more resistant organisms, but extended infusion did not increase the MICs up to which target attainment could be achieved.

CONCLUSIONS

Meropenem dosing should be based on renal function rather than age. For patients without renal impairment, extended infusion may increase the probability of target attainment.

The effects of UGT1A4 and ABCB1 polymorphisms on clozapine and N- desmethyl clozapine plasma levels in Turkish schizophrenia patients

Clozapine (CLZ) is an antipsychotic which is particularly used in treatment resistant schizophrenia patients who do not respond to other agents. It is preferred because it reduces suicidal behaviours and attempts, reducing aggression and violent behaviour. The aim of the study is to evaluate the effects of ABCB1 rs1045642 and UGT1A4 rs2011425 polymorphisms on CLZ and its major metabolite N- desmethly clozapine (DCLZ) plasma concentrations in patients with schizophrenia. A total 109 of Turkish patients with schizophrenia on continually administered CLZ monotherapy were included. The plasma concentrations of CLZ and DCLZ were measured using an HPLC after liquid-liquid extraction while, transporter gene ABCB1 and phase two enzyme UGT1A4 polymorphisms were identified using PCR- RFLP method. Results showed that UGT1A4*3 polymorphism has statistically significant effects on CLZ C/D and DCLZ C/D levels in patients with sub/supra therapeutic levels while ABCB1 C3435T polymorphism has a significant effect on CLZ/DCLZ ratio among patients who have subtherapeutic levels. This study indicates the influence of genetic differences on plasma levels and highlights the importance of pharmacogenetic studies in clinic. Using the obtained results as pharmacogenetic biomarkers will help clinicians provide effective treatment in individual patients and reduce the undesirable side effects.

Artificial intelligence modeling of biomarker-based physiological age: Impact on phase 1 drug-metabolizing enzyme phenotypes

Age and aging are important predictors of health status, disease progression, drug kinetics, and effects. The purpose was to develop ensemble learning-based physiological age (PA) models for evaluating drug metabolism. National Health and Nutrition Examination Survey (NHANES) data were modeled with ensemble learning to obtain two PA models, PA-M1 and PA-M2. PA-M1 included body composition, blood and urine biomarkers, and disease variables as predictors. PA-M2 had blood and urine-derived variables as predictors. Activity phenotypes for cytochrome-P450 (CYP) CYP2E1, CYP1A2, CYP2A6, xanthine oxidase (XO), and N-acetyltransferase-2 (NAT-2) and telomere attrition were assessed. Bayesian networks were used to obtain mechanistic systems pharmacology model structures for PA. The study included n = 22,307 NHANES participants (51.5% female, mean age 46.0 years, range: 18-79 years). The PA-M1 and PA-M2 distributions had greater dispersion across age strata with a right skew for younger age strata and a left skew for older age strata. There was no evidence of algorithmic bias based on sex or race/ethnicity. Klotho, lean body mass, glycohemoglobin, and systolic blood pressure were the top four predictors for PA-M1. Glycohemoglobin, serum creatinine, total cholesterol, and urine creatinine were the top four predictors for PA-M2. The models also performed satisfactorily in independent validation. Model-predicted PA was associated with CYP2E1, CYP1A2, CYP2A6, XO, and NAT-2 activity. Telomere attrition was associated with greater PA-M1 and PA-M2. Ensemble learning models provide robust assessments of PA from easily obtained blood and urine biomarkers. PA is associated with Phase I drug-metabolizing enzyme phenotypes.

Ketone monoester ingestion improves cardiac function in adults with type 2 diabetes: a double-blind, placebo-controlled, randomized, crossover trial

Type 2 diabetes (T2D) is a metabolic disease associated with cardiovascular dysfunction. The myocardium preferentially uses ketones over free fatty acids as a more energy-efficient substrate. The primary aim was to assess the effects of ketone monoester (Kme) ingestion on cardiac output index ([Formula: see text]i). The secondary aims were to assess the effects of Kme ingestion on markers of cardiac hemodynamics, muscle oxygenation, and vascular function at rest, during and following step-incremental cycling. We undertook a double-blind, randomized, crossover design study in 13 adults [age, 66 ± 10 yr; body mass index (BMI), 31.3 ± 7.0 kg·m-2] with T2D. Participants completed two conditions, where they ingested a Kme (0.115 g·kg-1) or a placebo taste-matched drink. Cardiac function was measured using thoracic impedance cardiography, and muscle oxygenation of the calf was determined via near-infrared spectroscopy. Macrovascular endothelial function was measured by flow-mediated dilation (FMD), and microvascular endothelial function was measured via transdermal delivery of acetylcholine (ACh) and insulin. Circulating β-hydroxybutyrate [β-Hb] was measured throughout. Kme ingestion raised circulating β-Hb throughout the protocol (peak 1.9 mM; P = 0.001 vs. placebo). Kme ingestion increased [Formula: see text]i by 0.75 ± 0.5 L·min-1·m-2 (P = 0.003), stroke volume index by 7.2 ± 4.5 mL·m-2 (P = 0.001), and peripheral muscle oxygenation by 9.9 ± 7.1% (P = 0.001) and reduced systemic vascular resistance index by -420 ± -225 dyn·s-1·cm-5·m-2 (P = 0.031) compared with the placebo condition. There were no differences between Kme and placebo in heart rate (P = 0.995), FMD (P = 0.542), ACh max (P = 0.800), and insulin max (P = 0.242). Ingestion of Kme improved [Formula: see text], stroke volume index, and peripheral muscle oxygenation but did not alter macro- or microvascular endothelial function in people with T2D.NEW & NOTEWORTHY For the first time, we show that acute ketone monoester ingestion (Kme) can increase cardiac output and stroke volume and reduce systemic vascular resistance at rest and during exercise in sodium glucose transporter inhibitors naïve (i.e. no drug-induced ketosis) people with type 2 diabetes. Acute Kme ingestion improves peripheral skeletal muscle oxygenation during moderate intensity and maximal exercise. Kme has no effect on macro- or microvascular endothelial function in people with type 2 diabetes.

Guideline-directed Medical Therapy in Nonagenarians and Centenarians (≥ 90 Years Old) After First-onset Myocardial Infarction---a National Registry Study

BACKGROUND

Guideline-directed medical therapies (GDMTs), such as beta-blockers, antiplatelet drugs, lipid-lowering drugs, and renin-angiotensin system agents, have been associated with reduced risk of mortality after acute myocardial infarction (AMI). However, this survival benefit conferred by GDMTs in nonagenarians and centenarians (≥ 90 years old) is not well-defined.

METHODS

We investigated restricted mean survival times of patients ≥ 90 years of age with first-onset AMI treated with GDMTs from 2007 to 2020 in the Singapore Myocardial Infarction Registry. Primary analyses involved stratification by number of GDMTs prescribed at discharge, with derivation of pairwise restricted mean survival ratios free from all-cause mortality at 1, 3, and 5 years. Secondary analyses evaluated individual GDMTs within combinations of 1-3 GDMTs.

RESULTS

The analysis included 3264 patients: 0 GDMTs (561 patients, 17.2%), 1-2 GDMTs (1294 patients, 39.6%), 3 GDMTs (904 patients, 27.7%), and 4 GDMTs (505 patients, 15.5%), with a median follow-up duration of 5.71 years. Patients who received 4 GDMTs at discharge were younger, had more comorbidities, were more likely to be smokers, and were more likely to have undergone percutaneous coronary intervention than those prescribed fewer GDMTs. A greater number of GDMT classes at discharge was associated with longer survival free from all-cause mortality at 1, 3, and 5 years. Each drug class within combinations of 1-3 GDMTs was associated with significant survival benefit at all time points, except for beta-blockers.

CONCLUSIONS

Prescription of any number of GDMTs to nonagenarians and centenarians after first-onset AMI is associated with significant survival benefit.

Burden of inflammatory bowel disease among elderly, 1990-2019: A systematic analysis based on the global burden of disease study 2019

AIM

The number of elderly patients with inflammatory bowel disease (IBD) has increased dramatically over the past few decades. Understanding the global burden of IBD in the elderly can provide a valuable basis for formulating future healthcare policies. This study aimed to comprehensively assess the global burden of IBD in the elderly from 1990 to 2019.

METHODS

We extracted prevalence, incidence, disability-adjusted life-years (DALYs), and mortality data of older adults (60-89 years old) with IBD from 2010 to 2019 from the Global Burden of Disease (GBD) Study 2019, and analyzed in subgroups according to region, country, Socio-demographic Index (SDI), age group, and gender. Additionally, Trends in the global burden of IBD in old age from 1990 to 2019 were analyzed by calculating the estimated annual percentage change (EAPC) in the age-standardized rates (ASDs).

RESULTS

From 1990 to 2019, the number of prevalent cases, incident cases, DALYs, and deaths of IBD in older adults increased significantly. Age-standardized rates of incidence, prevalence, DALYs, and mortality all trended downward. Americas, European regions, and high SDI countries had consistently high burdens. Middle SDI countries had the fastest growth in prevalence, incidence, and the fastest decline in DALYs, and mortality. The age-standardized rates of prevalence, incidence, and DALYs for IBD in the elderly were highest in the 60-64 age group, and age-standardized rates of mortality were highest in the 80-84 and 85-89 age groups. No gender differences were observed when stratified by gender.

CONCLUSIONS

IBD in older adults has become a global public health burden due to significant increases in the number of prevalent cases, incident cases, DALYs, and deaths. There are marked differences among regions, countries, and between different age groups. Public health practitioners should develop targeted policies to effectively reduce the disease burden of IBD in older adults.

Prevalence and predictors of sub-optimal laboratory monitoring of selected higher risk medicines in Irish general practice: a 5-year retrospective cohort study of community-dwelling older adults

OBJECTIVES

To describe the prevalence of sub-optimal monitoring for selected higher-risk medicines in older community-dwelling adults and to evaluate patient characteristics and outcomes associated with sub-optimal monitoring.

STUDY DESIGN

Retrospective observational study (2011-2015) using historical general practice-based cohort data and linked dispensing data from a national pharmacy claims database.

SETTING

Irish primary care.

PARTICIPANTS

625 community-dwelling adults aged ≥70 years and prescribed at least one higher-risk medicine during the 5-year study period.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the prevalence of sub-optimal laboratory monitoring using a composite measure of published medication monitoring indicators, with a focus on commonly prescribed higher-risk medicines such as diuretics and anticoagulants. Poisson regression was used to assess the patient characteristics associated with sub-optimal monitoring and explanatory variables included the number of medicines, age, sex, deprivation and anxiety/depression symptoms. Logistic regression was used to explore the association between baseline sub-optimal monitoring and the odds of adverse health outcomes (unplanned healthcare utilisation, adverse drug reactions and mortality).

RESULTS

Of 625 participants, the mean age was 77.7 years, 53% were female, the mean number of drugs was 7.3 (SD 3.3) and 499 (79.8%) had ≥1 unmonitored dispensing over 5 years. The number of drugs, deprivation and anxiety/depression symptoms were significantly associated with sub-optimal monitoring, with the strongest association seen for anxiety/depression symptoms (incidence rate ratio: 1.33, 95% CI 1.05 to 1.68). There was a small but significant association between baseline sub-optimal monitoring and emergency department visits at follow-up, but no evidence of an association with unplanned hospital admissions, mortality or adverse drug reactions.

CONCLUSION

The prevalence of sub-optimal medication monitoring was high, and number of drugs, deprivation and anxiety/depression symptoms were significantly associated with sub-optimal monitoring. However, the public health impact of these findings remains uncertain, as there was no clear evidence of an association between sub-optimal monitoring and adverse health outcomes. Further research is needed to evaluate the effect of improved monitoring strategies and the optimal timing for drug monitoring of higher risk medications.

Age-dependent effects of SGLT2 inhibitors on stroke risk in geriatric patients with diabetes and atrial fibrillation

BACKGROUND

Atrial fibrillation (AF) and diabetes mellitus (DM) are associated with an increased risk of ischemic stroke, particularly in geriatric populations. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated cardiovascular benefits, but their effects on stroke risk may vary by age. This study aimed to explore the age-dependent effects of SGLT2i on stroke risk in patients with AF and DM.

METHODS

This historical longitudinal follow-up cohort study included 9,669 patients with AF and DM from the National Taiwan University Hospital database (2010-2020). Patients were stratified into three age groups (< 75, 75-89, and ≥ 90 years) to compare SGLT2i users and non-users within each age group. Cox proportional hazards models were used to evaluate stroke risk, adjusting for CHA₂DS₂-VASc score and oral anticoagulant use. Interaction analysis assessed age-specific SGLT2i effects.

RESULTS

In patients aged < 75 years, SGLT2i use significantly reduced stroke risk (HR 0.63, 95% CI 0.44-0.88, P < 0.05). Stroke risk was neutral in patients aged 75-89 years (HR 0.95, 95% CI 0.60-1.50), but significantly increased in those aged ≥ 90 years (HR 5.04, 95% CI 1.20-21.1, P < 0.05). Interaction analysis confirmed a significant age-dependent effect (aged ≥ 90 years x SGLT2i use HR 6.39, 95% CI 1.49-27.40, P < 0.05).

CONCLUSIONS

The impact of SGLT2i on stroke risk varies significantly by age. While protective in younger patients, SGLT2i may increase stroke risk in those aged ≥ 90 years. These findings highlight the importance of age-specific considerations in prescribing SGLT2i for patients with AF and DM.

Gender-Specific Patterns of Injury in Older Adults After a Fall from a Four-Wheeled Walker (Rollator): Retrospective Study from a Swiss Level 1 Trauma Centre

AIM

As the population is aging, falls by older people, in particular falls from four-wheeled walkers ("rollators"), are a growing problem. These falls must be examined by targeted research and interventions that incorporate gender differences. Therefore, this study examined the injury patterns of elderly patients admitted to a tertiary trauma centre in Switzerland after falls from rollators and focussed on gender differences.

METHODS

This was a retrospective single-centre study for the period from May 2012 to December 2019 which included elderly patients (≥65 years) who had suffered a fall from a rollator. Injury history, patient data, demographic information, and patient outcomes were compared between males and females, with the data sourced from the Ecare patient database, which contains all information related to patient visits and treatment procedures.

RESULTS

A total of 152 eligible patients were included in the analysis, with 56.6% hospitalised at our facility and 14.5% transferred to another hospital. The cohort comprised 50 (32.9%) males and 102 (67.1%) females. Males were more prevalent in the 75-84 age group, while females predominated in the 85 and older group, and this difference was statistically significant (p = 0.043). Osteoporosis was significantly more common in females (37.3% vs. 10%, p ≤ 0.001). Consequently, treatment with vitamin D and/or calcium was also significantly more prevalent among women (29.4% vs. 8%, p = 0.003). Most falls occurred at home (22.4%) or in nursing care facilities and rehabilitation centres (22.4%), without gender-based differences (p = 0.570). Men were six times more likely than women to sustain injuries when under the influence of alcohol (p = 0.002). Fractures to the lower extremities were the most common injuries, accounting for 34.2% of all injuries, with no statistically significant differences between groups (p = 0.063). Head injuries occurred in 34.9% of patients, with a trend towards more injuries in males (44% vs. 30.4%, p = 0.098). The cumulative rates of fractures to the pelvis, upper extremities, and lower extremities were significantly higher in females (59.8%) than in males (38%), p = 0.011. In-hospital mortality was significantly higher in men than in women (12.9% vs. 2.9%, p = 0.026). Operative procedures were significantly more common in women (33% vs. 16.3%; p < 0.001).

CONCLUSION

Women were more frequently affected by falls related to rollators than men. Most falls occurred at home, in nursing care facilities, or rehabilitation centres, with no significant gender-based differences. There was a trend toward more head injuries in males, while the cumulative fracture rate of the pelvis, upper extremities, and lower extremities was significantly higher in females. In-hospital mortality was more than four times higher in men. These findings may guide the development of gender-specific interventions to reduce rollator-related injuries in the vulnerable elderly population.

Barriers and facilitators to the implementation of PHAROS, a perioperative pharmaceutical management intervention for older adults - a qualitative interview study from the perspective of healthcare providers

BACKGROUND

Number of drugs are increasing with older age and present a risk factor for various adverse health outcomes. A comprehensive medication therapy management (MTM) before admission for elective surgery may help reduce unnecessary and potentially inadequate medications (PIM) and thus improve patient health. Our goal was to evaluate the implementation of PHAROS, a perioperative MTM intervention study, from the perspective of health care providers. The PHAROS intervention aimed to improve medication appropriateness in older inpatients at the outpatient / inpatient interface.

METHODS

We performed a qualitative interview study within a pilot intervention study comparing a comprehensive MTM with standard care in older inpatients (≥ 65 years) in Germany. Semi-structured interviews with health care professionals were performed from March to July 2021. The Consolidated Framework for Implementation Research (CFIR) was used to guide development of interview guide, data coding, analysis, and reporting of findings.

RESULTS

Ten health care professionals involved in the implementation of PHAROS were interviewed. Based on CFIR-constructs, facilitators included need for and meaningfulness of the intervention as well as positive and supportive cooperation within the project team. Implementation of MTM at the interface of inpatient to outpatient care before elective surgery was hampered by personal and organizational barriers as well as barriers resulting from broader health care structures in Germany. In particular, lack of documentation standards, missing compatibility with clinical workflow, difficulties in stakeholder engagement, as well as communication barriers between outpatient and inpatient care interfaces hindered implementation of the intervention.

CONCLUSIONS

Further studies should consider focusing on facilitators to pharmaceutical implementations such as transparent and clear communication structures between stakeholders, standardization of medication documentation, and intervention structures that are adapted to hospital workflows.

TRIAL REGISTRATION

https://drks.de Identifier: DRKS00014621, this study was part of the PHAROS study.

PK/PD-Guided Strategies for Appropriate Antibiotic Use in the Era of Antimicrobial Resistance

Antimicrobial resistance (AMR) poses a critical global health threat, necessitating the optimal use of existing antibiotics. Pharmacokinetic/pharmacodynamic (PK/PD) principles provide a scientific framework for optimizing antimicrobial therapy, particularly to respond to evolving resistance patterns. This review examines PK/PD strategies for antimicrobial dosing optimization, focusing on three key aspects. First, we discuss the importance of drug concentration management for enhancing efficacy while preventing toxicity, considering various patient populations, including pediatric and elderly patients with their unique physiological characteristics. Second, we analyze different PK modeling approaches: the classic top-down approach exemplified by population PK analysis, the bottom-up approach represented by physiologically based PK modeling, and hybrid models combining both approaches for enhanced predictive performance. Third, we explore clinical applications, including nomogram-based dosing strategies, Bayesian estimation, and emerging artificial intelligence applications, for real-time dose optimization. Critical challenges in implementing PK/PD simulation are addressed, particularly the selection of appropriate PK models, the optimization of PK/PD indices, and considerations concerning antimicrobial concentrations at infection sites. Understanding these principles and challenges is crucial for optimizing antimicrobial therapy and combating AMR through improved dosing strategies.

A Comprehensive 10-Year Nationwide Pharmacovigilance Surveillance on Antibacterial Agents in Korea: Data Mining for Signal Detection of Trends and Seriousness of Adverse Events

A comprehensive pharmacovigilance surveillance on antibacterials is lacking. This study aims to investigate safety signals of antibacterial-related adverse drug events (ADEs) with seriousness and to identify predictors of serious ADEs. This study investigated 52,503 antibacterial-induced ADEs reported to the Korea Adverse Event Reporting System Database from January 2013 to December 2022. Disproportionality analysis was conducted, and the effect sizes were estimated by reporting odds ratios (ROR), proportional reporting ratio (PRR), and information component (IC). Multivariate logistic regression was performed to investigate the predictors of serious ADEs by estimating the odds ratio (OR). Serious events were more likely to be cardiovascular disorders (ROR 6.77, PRR 6.6, IC 2.37), urinary system disorders (ROR 5.56, PRR 5.22, IC 2.12), and platelet, bleeding, and clotting disorders (ROR 5.41, PRR 5.17, IC 2.06). The predictors may include age (OR 1.05), the number of concomitant medications (OR 1.44), concomitant proton pump inhibitors (OR 1.46) and non-steroidal anti-inflammatory drugs (OR 1.38) use, and specific antibacterial classes, while multiple antibacterial therapy was associated with lower serious ADE risks. The sensitivity analysis also suggests the male sex (OR 1.18) as a potential predictor of serious ADEs. However, further studies are imperative to determine the causality of antibacterial-induced ADEs in critically ill patients.