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Background:An ongoing debate revolves around whether axial spondyloarthritis (axSpA) with psoriasis and psoriatic arthritis (PsA) with axial involvement (axPsA) constitute the same disease or separate entities. The discussion is intensified by the absence of a universally accepted definition for axPsA. With regards to biologic disease-modifying antirheumatic drugs (bDMARDs), both tumor necrosis factor and interleukin-17 inhibitors (TNFi and IL-17i, respectively) have proven effective in both axSpA and PsA. However, interleukin-23 inhibitors (IL-23i) have demonstrated efficacy in PsA but not in axSpA. Post-hoc analyses of randomized controlled trials (RCTs) of IL-23i in PsA suggest, however, that this drug class might also be efficacious in axPsA.Objectives:To compare the retention of TNFi, IL-17i and IL-23i in patients with axPsA in a large national observational cohort of PsA patients treated under real-life conditions.Methods:Patients diagnosed with PsA were included in this study if their treating rheumatologist confirmed the presence of axial involvement (based on their interpretation of clinical signs, symptoms, and imaging) in the online database of the national PsA registry at any time before the initiation of bDMARD treatment. Treatment with TNFi, IL-17i, and IL-23i was considered if started between 2015 and 2023, as all three modes of action were approved for the treatment of PsA during this period. Drug retention was investigated using mixed-effects Cox proportional hazards models adjusted for covariates, including age, sex, presence of enthesitis or peripheral arthritis, current smoking, obesity, degree of cutaneous psoriatic involvement (at least moderate-severe vs. ≤ mild-moderate), start of the treatment course (TC) 2019-2023 vs. 2015-2018, and the number of bDMARDs and targeted synthetic (ts-)DMARDs previously utilized. Sensitivity analyses were performed with additional adjustments for the level of C-reactive protein and co-medication with conventional synthetic (cs)DMARDs. The analyses accounted for the possibility that some patients might have been treated with several drugs of the same class, as well as with drugs of different classes.Results:A total of 952 TCs in 543 patients with axPsA met the inclusion criteria. Among these, 364 TCs had available information on covariates and were included in the adjusted analyses (219 TNFi, 97 IL-17i (84 secukinumab and 13 ixekizumab), and 48 IL-23i (33 ustekinumab and 15 guselkumab)). Patients were older and had a longer symptom duration at start of IL-17i and IL-23i TCs compared to TNFi (Table 1). While the distribution of patients with peripheral arthritis was similar between the groups, the proportion of patients with enthesitis was lower at the start of IL-23i. AxPsA patients starting IL-17i and IL-23i exhibited more severe skin disease, aligning with the established superior efficacy of these drugs for psoriatic skin disease compared to TNFi. Patients initiating IL-17i and IL-23i had experienced a higher number of previous bDMARD failures. The adjusted analysis revealed no evidence for a difference between drug discontinuation between IL-17i vs. TNFi and IL-23i vs. TNFi (HR 0.98, 95% CI 0.68-1.41; and HR 1.01, 95% CI 0.62-1.63, respectively) (Table 2). These results were confirmed after additional adjustment for CRP and co-medication with a csDMARD (HR 1.08, 95% 0.71-1.63 for IL-17i vs. TNFi and HR 0.98, 95% CI 0.56-1.69 for IL-23i vs. TNFi).Table 1. Patient characteristics at the start of individual treatment courses (N = 364) stratified by drug class: TNFi, IL-17i, and IL-23i, respectively.Table 2. Mixed-effects Cox proportional hazards models for analysis of drug discontinuation of a bDMARD in PsA patients with axial involvement. (Analysis performed in 364 treatment courses in 275 patients with 244 discontinuation events).Conclusion:While the profiles of axPsA patients treated with IL-17i and IL-23i differed from those treated with TNFi, our data do not demonstrate a significant difference in drug retention among the three drug classes after adjusting for potential confounding.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of Interests:Adrian Ciurea: None declared, Andrea Goetschi: None declared, Burkhard Moeller Speaking fees from Janssen, Novartis, Pfizer, Eli Lilly, Grant/Research support from Amgen, Michael J. Nissen Speaking fees from AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, Amgen, Consulting fees from AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, Research grant from Novartis, Pfizer, Kristina Buerki: None declared, René Braem: None declared, Michael Andor: None declared, Thomas Hügle Payments for lectures and presentations from Pfizer, Fresenius Kabi, AbbVie, Merck Sharp and Dohme, Galapagos, Eli Lilly and Novartis, Holds stock or stock options of Atreon SA and Vtuls, royalties from Curmed, Pariticapted on Advisory Boards for DETECTRA, Andrea Rubbert-Roth Honoraria for lectures from AbbVie, Janssen, Novartis and Pfizer, Consulting fees from AbbVie, Janssen and Pfizer, Support for attending meetings from Janssen, Pfizer, Diego Kyburz Honoraria for presentations from AbbVie, Eli Lilly, Payments for participation on advisory boards from AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Research grant from AbbVie, support for attending meetings from Janssen and Eli Lilly, Sabine Adler: None declared, Oliver Distler: None declared, Almut Scherer Employed by Bristol-Myers-Squib in 2007-2008, Raphael Micheroli Honoraria for lectures or presentations from AbbVie, Eli Lilly, Janssen, Gilead, Pfizer.

Background:In psoriatic arthritis (PsA), the assessment of TNFi treatment outcomes primarily focuses on the improvement in the number of affected joints, disregarding their specific locations. Transcriptomic variances identified in synovial fibroblasts (SF) from various joint sites in rheumatoid arthritis translated into joint-specific SF phenotypes with distinct characteristics and responsiveness to cytokines. These findings suggest that various joints may potentially respond differently to specific immunosuppressive treatments.Objectives:To investigate whether joints at different anatomical locations might respond differently to TNFi treatment in patients with PsA.Methods:PsA patients starting a first TNFi between 2000 and 2022 in eight European registries met the following additional inclusion criteria: age ≥18 years, TNFi initiation as monotherapy or added to methotrexate, and at least one swollen joint out of 28 at treatment start (baseline). The primary outcome was time to the first resolution of joint swelling on the individual joint level, assessed at baseline and at 6, 12, 18, and 24 months. Hazard ratios (HR) for resolution comparing different joint locations were estimated using interval-censored mixed-effects Cox proportional hazards models. The nested data structure was accounted for by including a random effect for the country and the patient. Analyses were adjusted for age and sex.Results:A total of 1729 patients with 8397 swollen joints at baseline met the inclusion criteria. The proportion of women was 54%. The proportion of patients on concomitant methotrexate was 77%. The mean (SD) age was 49.4 (12.1) years, and the symptom duration 9.0 (8.6) years. The mean number of swollen and tender joints at baseline was 4.8 (4.1) and 7.4 (6.0), respectively, with a mean disease activity score using the C-reactive protein (DAS28-CRP) of 4.7 (1.0). The proportion of patients with joint swelling at specified locations at baseline is depicted in Figure 1. Concerning the upper limb and using the response of the proximal interphalangeal joint of the third digit (PIP3) as a reference, a significantly higher rate of resolution of joint swelling was observed for the elbow and the shoulder (HR 1.80, 95% CI 1.29-2.51 and HR 1.56, 95% CI 1.08-2.26, respectively) (Figure 2). In contrast, a lower rate of resolution of joint swelling was found for the wrist in relation to the PIP3 joint (HR 0.68, 95% CI 0.56-0.82, Figure 2). No evidence for a difference in resolution of joint swelling was found for the knee in comparison to the elbow (HR 0.78, 95% CI 0.51-1.20).Figure 1.Proportion of the 1729 PsA patients with joint swelling at specified locations at initiation of TNFi.Figure 2.Interval-censored mixed-effects Cox proportional hazards model estimating HRs and 95% CI for resolution of joint swelling of joints along the upper limb after initiation of a first TNF inhibitor in PsA patients (N=953). The numbers in brackets at each site refer to the number of swollen joints and the number of patients. MCP3 = metacarpophalangeal joint of digit 3; PIP3 = proximal interphalangeal joint of digit 3.Conclusion:The clinical response of articular inflammation to a TNFi in PsA, in terms of time to the first resolution of joint swelling, appears to depend on joint location. This suggests that local factors, such as differences in mechanical factors or synovial fibroblast phenotypes, might impact treatment effectiveness at specific joints. Future analyses exploring whether joint specific responses in PsA are associated with distinct therapeutic modes of action are warranted.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of Interests:Adrian Ciurea: None declared, Seraphina Kissling: None declared, Andrea Goetschi: None declared, Lykke Midtbøll Ørnbjerg Research grant from Novartis, Simon Horskjær Rasmussen Research grant from Novartis, Bálint Tamási: None declared, Burkhard Moeller Speakers bureau: Eli-Lilly, Janssen, Novartis, Pfizer, Grant/research support: Amgen, Michael J. Nissen Speaker fees from AbbVie, Amgen, Eli Lilly, Janssens, Novartis, Pfizer, Consulting fees from AbbVie, Eli Lilly, Janssens, Novartis, Pfizer, Research grants from Novartis and Pfizer, Bente Glintborg Research grants from Pfizer, AbbVie, BMS, Sandoz, Anne Gitte Loft Speaking and/or consulting fees from AbbVie, Janssen, Lilly, MSD, Novartis, Pfizer, UCB, Speaking and/or consulting fees from AbbVie, Janssen, Lilly, MSD, Novartis, Pfizer, UCB, Research grant from Novartis, João Madruga Dias: None declared, Paula Valente: None declared, Almut Scherer Employed by Bristol-Myers-Squib in 2007-2008, René Braem: None declared, Karel Pavelka Consultant: AbbVie, UCB, Pfizer, Eli Lilly, Celltrion, MSD, and Novartis, Jakub Zavada Speakers bureau: AbbVie, Elli-Lilly, Sandoz, Novartis, Egis, UCB, Sanofi, Astra Zeneca, Sobi, Bjorn Gudbjornsson Speaking fees from Novartis and Nordic-Pharma, Consulting fees from Novartis, Olafur Palsson: None declared, Gareth T. Jones Speaker fee from Janssen, Research grants (paid to employer) from AbbVie, Pfizer, UCB, Amgen, GSK, Gary J. Macfarlane Research grant from GSK, Catalin Codreanu Speaker fees from AbbVie, Amgen, Boehringer Ingelheim, Ewopharma, Lilly, Novartis, Pfizer, Consultancy fees from AbbVie, Amgen, Boehringer Ingelheim, Ewopharma, Lilly, Novartis, Pfizer, Corina Mogosan Speaker fees from AbbVie, Boehringer Ingelheim, Ewopharma, Lilly, Novartis, Pfizer, Vappu Rantalaiho Speakers bureau: Novartis, Viatris, Consultant: Pfizer, Ritva Peltomaa Consultant: AbbVie, Boehringer, Celltrion, Fresenius, Lilly, UCB, Isabel Castrejon Speaker and/or consultancy fees from BMS, Eli-Lilly, Galapagos, Gilead, Janssen, Novartis, MSD, Pfizer, GSK, Speaker and/or consultancy fees from BMS, Eli-Lilly, Galapagos, Gilead, Janssen, Novartis, MSD, Pfizer, GSK, Ziga Rotar Speakers bureau: Abbvie, Amgen, Novartis, MSD, Medis, Biogen, Eli Lilly, Pfizer, Sanofi, Lek, Janssen, Consultant: Abbvie, Novartis, Eli Lilly, Pfizer, Janssen, SOBI, Swixx BioPharma, AstraZeneca, Brigitte Michelsen Consulting fees from Novartis, Research grant from Novartis (paid to employer). Centre for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY) is funded as a Centre for Clinical Treatment Research by The Research Council of Norway (project 328657), Florenzo Iannone Consulting and/or speaking from Abbvie, Amgen, AstraZeneca, BMS, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, UCB, Consulting and/or speaking from Abbvie, Amgen, AstraZeneca, BMS, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, UCB, Research grant from BMS, Galapagos, Pfizer, Francesca Cozzini Speaker fees from Eli Lilly, Janssen, BMS, Pfizer, Galapagos, Boehringer-Ingheleim, Consultation fees from Eli Lilly, Janssen, BMS, Pfizer, Galapagos, Boehringer-Ingheleim, Research grant from BMS, Johan K Wallman Speaker fees from AbbVie, Amgen, Research support from AbbVie, Amgen, Eli Lilly, Novartis, Pfizer, Irene van der Horst-Bruinsma Speaker and/or consultancy fees from UCB. Fees received for Lectures from BMS, AbbVie, Pfizer, MSD, UCB, Consultant for Abbvie, UCB, MSD, Novartis, Lilly, Unrestricted Grants received for investigator initiated studies from MSD, Pfizer, AbbVie, UCB., Oliver Distler: None declared, Mikkel Østergaard Speaker and/or consultancy fees from Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, UCB, Speaker and/or consultancy fees from Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, UCB, Research grants from Abbvie, BMS, Merck, Novartis and UCB, Merete Lund Hetland Speaker for Pfizer, Medac, Sandoz (no personal income, institution), Advisory Board Abbvie (No personal income, paid to institution). Prev. chaired the steering committee of the Danish Rheumatology Quality Registry (DANBIO, DRQ), which receives public funding from the hospital owners and funding from pharmaceutical companies., Research grants (institution) from Abbvie, Biogen, BMS, Celltrion, Eli Lilly, Janssen Biologics B.V, Lundbeck Fonden, MSD, Medac, Pfizer, Roche, Samsung Biopies, Sandoz, Novartis, Nordforsk, Raphael Micheroli Honoraria for lectures or presentations from AbbVie, Eli Lilly, Janssen, Gilead, and Pfizer, Caroline Ospelt: None declared.

Background:It remains uncertain whether the concept of a “window of opportunity”, as defined for rheumatoid arthritis, applies to axial spondyloarthritis (axSpA). The Assessment in SpondyloArthritis international Society (ASAS) has published a consensus definition for “early” axSpA, which relies on axial symptom duration of ≤2 years [1]. Recent research using this definition has indicated that the effectiveness of treatment with tumor necrosis factor inhibitors (TNFi) is comparable in early and established disease [2]. To further explore the potential for improved outcomes in patients diagnosed and treated at an earlier stage, we here evaluate a shorter cut-off for the definition of early axial symptom duration.Objectives:To analyze the effectiveness of treatment with a first TNFi in patients with “very early” axSpA, defined as an axial symptom duration ≤1 year, in comparison to patients with established axSpA (axial symptom duration >2 years).Methods:Patients from a large national observational cohort of patients diagnosed as having axSpA were included in the current study if data on duration of axial symptoms was available and a first TNFi initiated between 2004 and 2023. Patients were stratified according to axial symptom duration: very early axSpA (≤1 year), early axSpA (>1 year and ≤2 years), and established axSpA (≥2 years). Drug retention was analyzed using Cox proportional hazards models, adjusting for age, sex, human leucocyte antigen B27 (HLA-B27) positivity, body mass index (BMI), education, smoking status, elevated C-reactive protein (CRP), and inflammation on magnetic resonance imaging (MRI) of the sacroiliac joints in patients with complete covariate information. Adjusted logistic regression analyses were employed to determine the achievement of the Bath Ankylosing Spondylitis Disease Activity Index criteria for 50% improvement (BASDAI50) at 12±6 months (intention-to-treat analyses in patients with available visits).Results:A total of 1080 patients met the inclusion criteria, with 131 in the very early axSpA group (12.1%), 75 in the early axSpA group (6.9%) and 874 in the established axSpA group. Characteristics of patients at the initiation of the first TNFi are presented in Table 1. Patients in the very early axSpA group were significantly younger, and had less impairment of spinal mobility. TNFi retention was analyzed in 594 patients with available covariate information (75 patients with very early axSpA, 31 patients with early axSpA and 488 patients with established disease; Table 2). We did not find evidence for a difference in retention between very early and established axSpA (HR for drug discontinuation 0.84, 95% CI 0.62-1.15, Table 2). Adjusted BASDAI50 response at 1 year was investigated in 422 patients with complete covariate data (55 patients with very early axSpA, 18 patients with early axSpA and 349 patients with non-early axSpA). A comparable BASDAI50 response was observed in very early vs. established axSpA (OR 0.85, 95% 0.44-1.64), and in early vs. established axSpA (OR 0.79, 95% 0.27-2.25).Table 1. Characteristics of axSpA patients with very early disease and non-early disease at initiation of the first tumor necrosis factor inhibitor. ASDAS = Ankylosing Spondylitis Disease Activity Score; axSpA = axial spondyloarthritis; BASDAI = Bath Ankylosing Spondylitis Disease Activity Index; BASFI = Bath Ankylosing Spondylitis Functional Index; BASMI = Bath Ankylosing Spondylitis Metrology Index; CRP = C-reactive protein; HLA-B27 = human leucocyte antigen-B27; MRI = magnetic resonance imaging).Table 2. Comparison of TNFi retention in patients with very early and early axSpA versus patients with established axSpA.Conclusion:Potential differences in effectiveness of TNFi in patients with very early and established axSpA are probably of a modest effect size, since, in our cohort, we did not find evidence for a difference between the two groups.REFERENCES:[1] Ann Rheum Dis 2023;doi:10.1136/ard-2023-224.232.[2] RMD Open 2023;9:e003455.Acknowledgements:NIL.Disclosure of Interests:Adrian Ciurea: None declared, Andrea Goetschi: None declared, Burkhard Moeller Speaking fees Janssen, Novartis, Pfizer, Eli Lilly, Grant/research support from Amgen, Michael J. Nissen Speaking fees from AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, Consulting fees from AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, Research grant from Novartis and Pfizer, Kristina Buerki: None declared, René Braem: None declared, Michael Andor: None declared, Thomas Hügle Payments for lectures and presentations from Pfizer, Fresenius Kabi, AbbVie, Merck Sharp and Dohme, Galapagos, Eli Lilly, Novartis, Holds stocks or stock options from Atreon SA and Vtuls, royalties from Curmed, Participated on Advisory board for DETECTRA, Andrea Rubbert-Roth Honoraria for lectures from AbbVie, Janssen, Novartis, Pfizer, Consulting fees from AbbVie, Janssen, Pfizer, Support for attending meetings from Janssen, Pfizer, Diego Kyburz Honoraria for presentations from AbbVie, Eli Lilly, Participation on advisory boards from AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Research grant from AbbVie, support for attending meetings from Janssen and Eli Lilly, Sabine Adler: None declared, Oliver Distler: None declared, Almut Scherer Employed by Bristol-Myers-Squib in 2007-2008, Raphael Micheroli Honoraria for lectures or presentations from AbbVie, Eli Lilly, Janssen, Gilead, and Pfizer.

Background and ImportanceMedication-related readmissions (MRRs) represent a significant burden on patients and healthcare systems. Despite the relevance of MRRs, a consensus on the most important risk factors is currently lacking.Aim and ObjectivesThis study aimed to develop a comprehensive set of indicators for 30-day MRRs through a consensus-based Delphi study. We sought to identify and prioritise key risk factors associated with MRRs.Material and MethodsWe assembled an expert panel consisting of clinical pharmacists, physicians, and nursing experts. The potential indicators were developed by conducting a scoping literature review (n = 20). The study team added eleven indicators not found in the existing literature but considered potentially relevant. The 31 proposed indicators were rated by the experts on a scale of 1 to 9 for relevance. Indicators with a median rating of 7 or higher were considered relevant. Consensus was determined using the RAND/UCLA method. In the second round, experts re-evaluated indicators without consensus and provided specifications for indicators requiring further detail.ResultsIn the first round, 38 experts participated, leading to the inclusion of 25 indicators and the exclusion of six. All indicators reached consensus, and five new indicators were suggested. In the second round, 34 experts participated, resulting in the inclusion of four out of five newly proposed indicators, all of which reached consensus. The expert panel prioritised the following indicators: (1) insufficient communication between different healthcare providers, (2) polypharmacy (seven or more medications), (3) low medication adherence (forgetting or administer medications wrongly at least twice per week), (4) complex medication regimen that involves taking at least three doses per day, using at least two different dosage forms, and administering them through at least two different routes each day, and (5) multimorbidity (three or more chronic conditions).Conclusion and RelevanceThe comprehensive set of MRR indicators developed in this study addresses the need for a standardised MRR risk assessment and offers a tool for pharmacists to prioritise clinical pharmacy services during hospital discharge. This could lead to more efficient resource allocation and potentially improve patient outcomes. Future work will focus on validating the identified indicators.References and/or AcknowledgementsConflict of InterestNo conflict of interest.

Chronic non-cancer pain (CNCP) is a disabling condition affecting many older adult inpatients. While first-line therapy for CNCP consists of non-pharmacological approaches, many older adults receive pharmacotherapy nevertheless, putting them at a high risk of medication-related problems. Quality indicators (QIs) for the pharmacological management of CNCP could help reduce this risk. This Delphi study aimed to establish the face validity and feasibility of a list of previously developed QIs for the pharmacological management of CNCP in older adult inpatients. We followed the RAND/UCLA Delphi study methodology to establish an expert consensus on a list of proposed QIs. Over two written rounds, nursing, pharmacy and medical experts rated the face validity and feasibility of the QIs identified in a previous systematic literature search. QI ratings that were uncertain or disagreed upon after the first round were discussed in three expert focus group discussions. The QIs discussed were rated again in round two, and the most relevant QI in each category was prioritised. Twenty-two experts agreed to participate in the study's deliberations. Nineteen experts (86%) returned their ratings in each written round, and 9 (41%) participated in the focus groups. They evaluated 61 proposed QIs, modified 11 of them and suggested 13 new ones. The final set consisted of 51 QIs, with the experts prioritising 23 different ones. The 51 QIs covered the categories of general pharmacotherapy and the appropriate use of opioids, non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol, metamizole and co-analgesics. Through consensus, we developed a first set of QIs for the pharmacological management of CNCP in older adult inpatients. This set will help standardise care, track and benchmark the quality of care, and be used as a trigger to prioritise patients for clinical or pharmacological interventions.

Opioids carry an inherent high risk of adverse drug events (ADEs), although these are generally predictable and avoidable through proper management and monitoring. Naloxone, an opioid antagonist, is used to counteract severe opioid overdoses. This study aimed to estimate the incidence of iatrogenic opioid overdoses and describe prescribing patterns before, during and after them. We conducted a ten-year retrospective case series analysis of naloxone use among inpatients at a large, multisite university hospital in Switzerland from January 2014 to December 2023. Cases were included if an adult patient had received naloxone after opioid administration and overdose. We excluded patients who received naloxone during surgery or in intensive care units. Of the 671 uses of naloxone identified, 121 (18.0%) met our inclusion criteria. Yearly naloxone use incidence was 11.0 per 10,000 inpatients, increasing slightly from 2014 to 2023. The median daily opioid dose requiring naloxone was 73 morphine milligram equivalents (MME). According to the Schumock and Thornton scale criteria, we considered 82 (67.8%) of the 121 opioid overdoses to have been potentially preventable The median opioid doses received before hospital admission (29.4 MME) were higher than at discharge (15.0 MME). Nevertheless, 71 (68.3%) of 104 discharged patients were still prescribed at least one opioid. This study found that iatrogenic opioid overdoses were relatively uncommon. However, the considerable number of preventable opioid overdoses estimated leads us to conclude that opioid stewardship programmes should be recommended across Switzerland.

Chronic non-cancer pain (CNCP) affects up to 88% of older adults. Pharmacological therapies are frequently prescribed long-term despite being considered second-line treatments and carrying significant risks, particularly for older adults. The present study aimed to clinically validate a set of quality indicators (QIs) that are used to improve the detection of medication-related problems during medication reviews performed by pharmacists for older adult inpatients with CNCP. We evaluated a set of medication review QIs-with previously established face and content validity-for a population of older adult inpatients diagnosed with CNCP. Subjects were in geriatrics wards in a tertiary hospital in Switzerland. Over two phases, pre- and post-QI implementation (Phase 1: July 2023 to April 2024, Phase 2: January to May 2025), pharmacists evaluated QIs for their applicability to the population, potential to improve medication reviews, acceptability by pharmacists, implementation issues and impact. These domains were used to evaluate the measurement properties of QIs in clinical practice, acting as proxies for clinical validity. Evaluations were interpreted using descriptive statistics. We included 89 patients in phase 1 and 48 in phase 2. Of the 38 QIs evaluated, 27 (71%) were applicable to ≥ 5% of patients, 21 (55%) showed the potential to improve medication reviews, 12 (32%) revealed relevant treatment discrepancies that pharmacists accepted, 6 (16%) were rated as problematic to implement, 10 (37%) were impactful according to our predefined criterion and 6 (16%) met all criteria. The clinical evaluation of our set of previously developed QIs could help pharmacists to efficiently detect medication-related problems among vulnerable older adult populations with CNCP. The fact that only a few of the QIs were clinically valid means that future research is required, including the measurement of the influence of these QIs on patient-reported outcomes.

Background Chronic non-cancer pain may affect up to 51% of the general population. Pharmacist interventions have shown promise in enhancing patient safety and outcomes. However, our understanding of the scope of pharmacists’ interventions remains incomplete. Aim Our goal was to characterise pharmacists’ interventions for the management of chronic non-cancer pain. Method Medline, Embase, PsycINFO via Ovid, CINAHL via EBSCO databases and the Cochrane Library were systematically searched. Abstracts and full texts were independently screened by two reviewers. Data were extracted by one reviewer, and validated by the second. Outcomes of studies were charted using the dimensions of the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). Results Forty-eight reports were included. Interventions ensuring appropriate drug prescription occurred in 37 (79%) studies. Patient education and healthcare professional education were reported in 28 (60%) and 5 (11%) studies, respectively. Therapy monitoring occurred in 17 (36%) studies. Interventions regularly involved interprofessional collaboration. A median of 75% of reported outcome domains improved due to pharmacist interventions, especially patient disposition (adherence), medication safety and satisfaction with therapy. Conclusion Pharmacists’ interventions enhanced the management of chronic non-cancer pain. Underreported outcome domains and interventions, such as medication management, merit further investigation.

BACKGROUND AND OBJECTIVE: Walking and cycling have shown beneficial effects on population risk of all-cause mortality (ACM). This paper aims to review the evidence and quantify these effects, adjusted for other physical activity (PA). DATA SOURCES: We conducted a systematic review to identify relevant studies. Searches were conducted in November 2013 using the following health databases of publications: Embase (OvidSP); Medline (OvidSP); Web of Knowledge; CINAHL; SCOPUS; SPORTDiscus. We also searched reference lists of relevant texts and reviews. STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS: Eligible studies were prospective cohort design and reporting walking or cycling exposure and mortality as an outcome. Only cohorts of individuals healthy at baseline were considered eligible. STUDY APPRAISAL AND SYNTHESIS METHODS: Extracted data included study population and location, sample size, population characteristics (age and sex), follow-up in years, walking or cycling exposure, mortality outcome, and adjustment for other co-variables. We used random-effects meta-analyses to investigate the beneficial effects of regular walking and cycling. RESULTS: Walking (18 results from 14 studies) and cycling (8 results from 7 studies) were shown to reduce the risk of all-cause mortality, adjusted for other PA. For a standardised dose of 11.25 MET.hours per week (or 675 MET.minutes per week), the reduction in risk for ACM was 11% (95% CI = 4 to 17%) for walking and 10% (95% CI = 6 to 13%) for cycling. The estimates for walking are based on 280,000 participants and 2.6 million person-years and for cycling they are based on 187,000 individuals and 2.1 million person-years. The shape of the dose–response relationship was modelled through meta-analysis of pooled relative risks within three exposure intervals. The dose–response analysis showed that walking or cycling had the greatest effect on risk for ACM in the first (lowest) exposure interval. CONCLUSIONS AND IMPLICATIONS: The analysis shows that walking and cycling have population-level health benefits even after adjustment for other PA. Public health approaches would have the biggest impact if they are able to increase walking and cycling levels in the groups that have the lowest levels of these activities. REVIEW REGISTRATION: The review protocol was registered with PROSPERO (International database of prospectively registered systematic reviews in health and social care) PROSPERO 2013: CRD42013004266.

To compare the seated flexion strength test (FST) with two modifications incorporating shoulder external rotation and supine positioning, aiming to improve serratus anterior (SA) selectivity through reduced upper (UT) and lower trapezius (LT) interference. Cross-sectional validation study using surface electromyography (EMG) and handheld dynamometry. University hospital musculoskeletal department. Eighteen healthy adults. EMG activation of SA, UT, LT and pectoralis major normalized to maximum voluntary contraction; activation ratios (UT/SA and LT/SA); force measurements with handheld dynamometer. Both modifications significantly reduced UT (p = 0.002) and LT activation (p = 0.010–0.049) compared to the FST without significantly reducing SA activity. The ratios (median UT/SA, LT/SA) showed a non-significant trend toward reduction in modification 1 (0.53, 0.57) and modification 2 (0.60, 0.41) compared to the FST (0.83, 0.71). Only modification 2 demonstrated excellent reliability (ICC 0.97, 95 % CI:0.92–0.99, MDC 14 %). The modification 2 (supine positioning, shoulder external rotation, 45° tilted dynamometer) enhances SA isolation and demonstrates superior reliability compared to the FST. Therefore, it may improve clinical assessment of SA strength particularly when differentiating from UT and LT is of interest. Further research is needed before applying these findings to patient populations. •High trapezius interference confirmed during flexion strength test.•Both modifications including external rotation and supine reduced trapezius EMG.•Excellent reliability in the modification applying a 45° tilted dynamometer.•Modified flexion strength test enhances validity for targeting serratus anterior.