Does the Life Skills Training program reduce use of marijuana?

The Life Skills Training (LST) program is one of the most widely disseminated drug prevention programs developed during the past 30 years. It is estimated that 50,000 teachers and 3 million students in the USA have participated in the program since 1995, and the program has been used in more than 30 other countries worldwide. This article reviews the evaluation studies that have assessed the effects of the LST program on the use of marijuana. Evaluations conducted by both the program developer and other research teams are reviewed. Most of the available evidence, especially coming from the analysis of data from full samples and not subgroup analysis, indicates that the program is unlikely to reduce use or abuse of marijuana among adolescents. The reason that the program has come to be considered so efficacious in preventing marijuana use is that those who promote the program pay little attention to the preponderance of evidence which supports the null hypothesis of no effect.     

Does a four-week delay in the introduction of medication alter the course of functional psychosis?

This study is an analysis of findings of a follow-up study of 105 patients with functional psychotic illness who had participated in a random and blind 4-week trial of pimozide, lithium, both and placebo. The intention was to examine the question of whether a 4-week delay in initiating antipsychotic treatment has a detrimental effect 2.5 years later. Detailed follow-up measures included need for care over the 2.5 years, treatments required, occupational decline, police contact, substance misuse, psychopathology and cognitive function. There was no evidence at all that those initially randomized to placebo had a poorer outcome in terms of any of these variables. It is concluded that a 4-week delay in initiating active treatment in patients with functional psychosis has no long-term adverse effects.     

Does the concordance concept serve patient medication management?

Objectives — To assess how people with arthritis evaluate and calibrate their complex medication regimens. Building on these findings, to explore how the concept of concordance helps to describe a patient‐provider partnership model which can aid optimum medication regimen selection, calibration and management of chronic conditions. Method — A longitudinal study of 689 patients diagnosed with osteoarthritis (OA) or rheumatoid arthritis (RA) was conducted to identify patient perceptions, decision‐making and behaviour related to their medication management. Face to face interviews with the Brief Medication Questionnaire, health quality of life questionnaires (AIMS2 and SF‐36) and telephone interviews were conducted in waves centered around patient visits every six months for two years. Data about medication regimens were abstracted from the clinic medication profile record for each visit. Setting — Three rheumatology clinics in the United States: a university clinic, a private clinic and a Veterans Administration clinic. Key findings — About half of the patients in the sample had complex regimens with eight or more medications at any one time. The majority of physicians altered patients' medication orders every six months. The majority of patients reported that they evaluated the effectiveness and side effects of individual medicines based largely on symptoms. There were 248 reported deviations in the scheduled medications at baseline and the majority (61 per cent) were intentional, largely based on symptoms. Conclusion — Providers and patients each had unique expertise and were engaged in a dynamic process of calibrating patients' ever‐changing regimens. In the absence of a perfect static regimen for patients, the concept of concordance productively reflects the partnership and mutual respect needed for ongoing medication regimen selection, calibration and management for a long‐term condition.     

Does hepatitis B virus therapy reduce the risk of hepatocellular carcinoma?

Introduction: Liver cancer is one of the most common cancers. Hepatocellular carcinoma (HCC) represents > 90% of primary liver cancers and is a major global health problem today. Chronic hepatitis B virus (HBV) infection is associated with more than half of HCCs.

Areas covered: Long-term therapy with nucleos(t)ide analogues (NUCs) improves outcomes in HBV-infected patients by slowing the progression of liver disease. It is associated with improvements in histological and clinical outcomes, improved patient survival, reduced need for liver transplantation and improved liver function in patients with decompensated liver disease. This review highlights the results of previous studies conducted on HCC prevention with long-term NUC therapy. Studies include the use of all available drugs in different clinical scenarios, and the comparison between treated and untreated patients.

Expert opinion: NUCs have been studied extensively in HCC prevention. A comprehensive review of the literature has shown that they can be safely and effectively used for this purpose. Despite some discrepancies between studies, most of the evidence favors using NUC therapy for HCC prevention.     

Does a physician's specialty influence the recording of medication history in patients' case notes?

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• Physicians undertake the documentation of medication history during clerking; where all the necessary information that guides the diagnostic and patient management tasks are obtained.
• Medication histories documented by physicians are often incomplete and generally sketchy; however, the impact of a physician''s specialty on the frequency and depth of medication history they document has not been studied.

WHAT THIS STUDY ADDS

• The depth and frequency of medication history documented by physicians is significantly influenced by their specialties.
• Physicians appear more interested in documenting more frequently and in greater depth medication history information that appears to aid diagnostic tasks in their specific specialty.

AIMS

To determine the impact of a physician''s specialty on the frequency and depth of medication history documented in patient medical records.

METHODS

A cross-sectional assessment of the frequency and depth of medication history information documented by 123 physicians for 900 randomly selected patients stratified across Cardiology, Chest, Dermatology, Endocrine, Gastroenterology, Haematology, Neurology, Psychiatry and Renal specialties was carried out at a 900-bed teaching hospital located in Ibadan, Nigeria.

RESULTS

Four hundred and forty-three (49.2%) of the cohort were males and 457 (50.8%) were females; with mean ages 43.2 ± 18.6 and 43.1 ± 17.9 years respectively. Physicians'' specialties significantly influenced the depth of documentation of the medication history information across the nine specialties (P < 0.0001). Post hoc pair-wise comparisons with Tukey''s HSD test showed that the mean scores for adverse drug reactions and adherence to medicines was highest in the Cardiology specialty; while the Chest specialty had the highest mean scores for allergy to drugs, food, chemicals and cigarette smoking. Mean scores for the use of alcohol; illicit drugs; dietary restrictions was highest for Gastroenterology, Psychiatry and Endocrine specialties respectively. Physicians'' specialties also significantly influenced the frequency of documentation of the medication history across the nine specialties (P < 0.0001).

CONCLUSIONS

Physicians appear to document more frequently and in greater depth medication history information that may aid the diagnostic tasks in their specific specialty. Researchers and other users of medication history data documented in patients'' medical records by physicians may want to take special cognizance of this phenomenon.     

Does the implementation of evidence-based and culturally competent practices reduce disparities in addiction treatment outcomes?

RationaleResearch is limited on the extent to which implementation of evidence-based and culturally responsive practices reduces outcome disparities in substance use disorder treatment. We examined the role of contingency management treatment (CMT), medication-assisted treatment (MAT), and culturally competent practices on Mexican Americans' rate of successful completion of treatment.MethodsWe analyzed a concatenated dataset from 153 publicly funded substance use disorder treatment programs in Los Angeles County, California, in 2011 and 2013. These data were merged with data from 15,412 adult clients in both periods, of whom we selected only Mexican Americans (46.3%) and non-Latino Whites (53.7%). The outcome was successful treatment completion. The main independent variables were client demographics, drug use severity, mental health issues, and program license and professional accreditation.ResultsLess than half of the programs highly implemented CMT, MAT, and culturally competent practices. CMT and cultural competence were not associated with successful treatment completion. However, Mexican Americans in programs with high degree of implementation of MAT had higher odds of successfully completing treatment compared to non-Latino Whites and programs with low MAT (OR = 1.389; 95% CI = 1.018, 1.897).ConclusionsFindings highlight the role of MAT in reducing the disparity in treatment completion between Mexican Americans and non-Latino Whites. Implications for health policy and the dissemination of MAT are discussed.     

Social distancing and the use of PPE by community pharmacy personnel: Does evidence support these measures?

Community pharmacists are one of the most accessible healthcare professionals and are often served as the first point of contact when it comes to minor ailments and health advice. As such, community pharmacists can play a vital role in a country's response to various preventative and public health measures amid the COVID-19 pandemic. Given the essential nature of community pharmacy as a health service, community pharmacies are unlikely to shut down in any foreseeable lockdown scenario. It is therefore important to assess the preventative measure directives for community pharmacies that are in place to safeguard community pharmacy personnel from SARS-CoV-2 in the various parts of the world. Upon reviewing the recommendations of 15 selected countries across five continents (Asia, Europe, Oceania, North America, and Africa) on social distancing and the use of personal protective equipment (PPE) in community pharmacies, we found inconsistencies in the recommended social distance to be practiced within the community pharmacies. There were also varying recommendations on the use of PPE by the pharmacy personnel. Despite the differences in the recommendations, maintaining recommended social distance and the wearing of appropriate PPE is of utmost importance for healthcare workers, including community pharmacy personnel dealing with day-to-day patient care activities, though full PPE should be worn when dealing with suspected COVID-19 patients.