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Mapping the Processes of Pharmacist Therapeutic Reasoning:A Scoping Review and Development of the Pharmacist Therapeutic Reasoning Model
No full textBackground: Pharmacists make complex therapeutic decisions. Yet the reasoning processes that result in these choices, therapeutic reasoning (TR), are poorly defined. Existing models of clinical reasoning often overlook how pharmacists weigh risks and benefits of treatment options. Aim: To develop a conceptual model that characterizes the processes, subprocesses, and cognitive strategies used during pharmacist TR based on current literature. Methods: A scoping review was conducted in February 2024 to identify studies describing pharmacist or pharmacy student reasoning during therapeutic decision-making. Data were extracted by two researchers using a standardized form and inductively analyzed. Codes were thematically organized based on shared properties: discrete knowledge, reasoning connections, or modifying influences. Theory use was assessed using the Continuum of Theory Talk framework. Results: Ten studies met inclusion criteria representing diverse contexts, scope, and reasoning stimuli. A total of 109 unique codes were identified and synthesized into a conceptual pharmacist therapeutic reasoning model (Pharm-TRv1). It consists of three knowledge domains (drug, disease, and patient information), three core reasoning processes connecting these domains (drug–patient, drug–disease, patient–disease), and three to four related subprocesses. The model includes five influencing factors: two external (decision context and entry and exit from reasoning) and three internal cognitive modifiers (metacognition, closing a knowledge gap, and reflection). Conclusion: Pharm-TRv1 provides a foundational model of pharmacist therapeutic reasoning grounded in current literature. It offers a structured way to describe, teach, and study how pharmacists evaluate treatment options. Future research should further explore specific processes and subprocesses, validate the model, and explore broader theoretical perspectives
Willingness to pay for animal welfare across labels, products, consumers, and time
No full textIn recent years, the number of labels indicating improved animal welfare conditions on meat products has increased making it difficult for consumers to understand, evaluate, and compare husbandry conditions across products. Based on a discrete choice experiment implemented in three cross-section surveys over a period of 15 months with a total of 6000 German respondents, we estimate the willingness to pay (WTP) for various levels of animal welfare associated with different meat products. We use three existing labels with overlapping animal welfare requirements mimicking the situation in the German meat market: The well-established organic label as well as a binary animal welfare label by the Animal Welfare Initiative and a multi-level animal husbandry label which were introduced in Germany in 2015 and 2019, respectively. We show that the multi-level label scheme leads to more product differentiation and, subsequently, higher WTP estimates. WTP further depends on meat type, where animal welfare improvements for beef and chicken products are valued much higher compared to those for pork. WTP for the organic and the highest level of the husbandry label increases with higher household incomes. WTP for these labels on chicken is also higher among women
Heart failure and left ventricular ejection fraction:a necessary but imperfect partnership
No full textThe left ventricular ejection fraction (LVEF) is the most commonly used index to assess left ventricular systolic function and guide management in patients with heart failure (HF). This is largely due to the widespread availability of echocardiography, its practicality, rapid scan time, ease of measuring left ventricular (LV) volumes, and its extensive application in both clinical practice and research. Accordingly, a recent joint clinical consensus statement from the Heart Failure Association (HFA) and the Heart Failure Society of America (HFSA) recommends that LVEF be evaluated longitudinally to assess disease trajectory, natural history, and response to treatment in patients with heart failure (6). However, there is little, if any, evidence that serial LVEF assessment improves risk stratification or guides management in HF. Notably, LVEF may not accurately reflect overall cardiac function. While it is commonly used as a measure of systolic function, LVEF does not fully capture the status of the heart. Other parameters-such as diastolic function, ventricular size, valvular function, and right ventricular function-also play important roles in determining patient risk. This paper proposes an alternative strategy, shifting from serial LVEF evaluation to a more comprehensive approach that includes assessment of congestion, right ventricular function, and structural myocardial damage to provide more robust diagnostic and prognostic information
In vitro kinematic analysis of a new patient-matched polycarbonate urethane radiocarpal interposition arthroplasty
No full textCurrent salvage procedures for patients with post-traumatic wrist osteoarthritis include excision of bone or tissue and/or fusion of wrist bones, making all surgical salvage procedures irreversible. Some of these salvage procedures decrease wrist mobility. A novel patient-matched polyurethane carbonate (PCU) radiocarpal interposition arthroplasty has recently been proposed as a reversible, motion-preserving solution. This experimental study evaluates the effect of the PCU radiocarpal implant on wrist range of motion (ROM) and carpal kinematics. Additionally, implant displacement is assessed during functional ROM. The passive wrist ROM of three cadaveric arms was measured in a wrist motion simulator before and after implantation of the PCU radiocarpal implant by applying a 1 Nm Torque. Three-dimensional fluoroscopy scans of the wrist were acquired in 15° steps during flexion-extension (F/E = 60°/60°) to assess carpal bone and implant kinematics. The mean differences in carpal kinematics between native and implantation conditions were calculated per cadaveric wrist and averaged across all three specimens. The mean wrist ROM did not demonstrate clinically relevant differences between the native and implantation conditions, except for a reduction of 10.3° in extension. Variations in carpal rotations and translations over the F/E curve were smaller than 2.5° and 2.2 mm and were therefore considered negligible. The PCU radiocarpal implants' rotations and translations were maximally 6.3° and 1.1 mm during F/E. Given these results, the PCU radiocarpal interposition arthroplasty may be a promising option for patients with post-traumatic radiocarpal arthritis, offering a balance between maintaining mobility and providing pain relief through a minimally invasive and reversible procedure
Response to comment on "The usefulness of the modified steep ramp test as a practical exercise test for preoperative risk assessment in patients scheduled for pancreatic surgery"
No full textAlcohol consumption and upper aerodigestive tract squamous cell carcinoma:evidence from 28 prospective cohorts
No full textBackground This study aimed to investigate the association between alcohol consumption and squamous cell cancers of the upper aerodigestive tract (UADT), using data from 28 cohorts within the Pooling Project of Prospective Studies of Diet and Cancer (DCPP). Methods Individual-level data from 2 365 437 participants were pooled. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox models to quantify the association between alcohol consumption (g/day) and UADT cancer risk, adjusting for potential confounders. Analyses were conducted by sex, smoking status, geographic region, and alcoholic beverages. Results Over a median follow-up of 15.5 years, 6903 UADT cancer cases were identified. Alcohol consumption was positively associated with UADT cancer risk overall. Even at intakes as low as 5-<15 g/day, the HR estimate was 1.12 (95% CI = 1.03 to 1.21) compared with the reference group (0.1-<5 g/day). The HR10 g/day (95% CI) was 1.16 (1.14 to 1.18) for women and 1.12 (1.11 to 1.13) for men (Pheterogeneity <. 0001). HR10 g/day estimates were 1.14 (1.13 to 1.15) in current, 1.10 (1.09 to 1.12) in former, and 1.15 (1.12 to 1.18) in never smokers. Consistent UADT HR10 g/day estimates were observed across all beverage types. HR10 g/day estimates varied across geographic regions, with HR10 g/day (95% CI) equal to 1.15 (1.14 to 1.17) in Europe-Australia, 1.13 (1.11 to 1.15) in Asia, and 1.11 (1.09 to 1.12) in North America (Pheterogeneity <. 0001). Conclusion Alcohol consumption was associated with UADT cancer risk, irrespective of smoking status or beverage type. However, due to differential baseline risks, alcohol is expected to impact the UADT cancer burden more in smokers than never smokers. These findings support public health strategies to reduce alcohol consumption.</p
A Criminal Law Shield for Nature
No full textCriminal law has been widely used around the world to protect nature, but how to structure it for optimal protection remains unclear. This Article proposes a framework for applying criminal liability to offenders who create a risk of harm or harm to nature. First, it offers three models for liability, including abstract endangering, actual endangering, and independent/autonomous crime. Second, criminal penalties applied should be effective, dissuasive, and proportionate, including fines and imprisonment as well as remedies that restore the original state of nature and prevent future damage. Third, when corporations commit crimes against natural resources, both the corporations and individuals involved should be subject to criminal liability. The Article finds features of the framework within international and regional instruments, such as (1) the Convention on International Trade in Endangered Species of Wild Fauna and Flora, (2) the Rome Statute, (3) the Conventions on the Protection of the Environment Through Criminal Law, and (4) the Environmental Crime Directives. However, several problems can impede enforcement of criminal nature conservation laws, including (1) limited capacity and knowledge of judicial authorities; (2) lack of deterrence/dissuasion of potential offenders; (3) poor enforcement at the national level; and (4) lack of international cooperation
Integrating Environmental Aspects into Health Technology Assessment:A Qualitative Study among Dutch Stakeholders
No full textBackground The Dutch National Health Care Institute (ZIN) advises the Dutch Minister of Health on the basic benefit package using Health Technology Assessment (HTA), focusing on necessity, clinical effectiveness, cost-effectiveness, and feasibility. Despite the huge environmental impact of the healthcare sector, this impact is not taken into consideration. Several methodological approaches to integrate the environmental impact into HTA have been proposed, including information conduit, integrated evaluation, parallel evaluation, and environment-focused evaluation. There is significant uncertainty as to which approach is the most appropriate. Therefore, it is important to understand stakeholders' perspectives on these approaches.Objectives To explore Dutch stakeholders' perspectives on integrating environmental impacts into HTA and assess preferred methods and challenges.Methods A qualitative study using a focus group with members from ZIN (n = 7) and individual interviews (n = 7) with experts in HTA, market access, and reimbursement. Interviews were transcribed and analyzed thematically.Results Stakeholders highlighted the importance of addressing environmental impacts such as pharmaceutical pollution, greenhouse gas emissions, and waste. Integrated and parallel evaluations were preferred, but barriers such as data gaps, methodological complexity, and lack of guidelines were noted.Conclusion Incorporating environmental impacts into HTA is crucial but requires clear guidelines, better data, and stakeholder collaboration to support sustainable healthcare practices
Parathyroid hormone receptor agonists in the management of osteoporosis
No full textParathyroid hormone (PTH) regulates bone homeostasis. Intermittent exposure to PTH results in bone formation being greater than bone resorption, and this effect has been harnessed through the development of agonists of the PTH and PTH-related protein type 1 receptor (PTH1R) to treat osteoporosis. Teriparatide, an analogue of the first 34 amino acids of PTH, and abaloparatide, which resembles PTH-related protein (PTHrP) in structure, are PTH1R agonists currently in clinical use. Both medications have been shown to increase bone mineral density at the lumbar spine, femoral neck and total hip. Randomized controlled trials with teriparatide or abaloparatide have also provided evidence of reduction in vertebral and non-vertebral fractures. The ACTIVE trial suggested slightly greater efficacy for major osteoporotic fractures (as an exploratory end point) for abaloparatide than for teriparatide. A similar potential superiority was suggested for hip fracture in a real-world, observational study. Side effects of these medications are usually transient, and although a risk of osteosarcoma was suggested by studies using murine models, no such risk has been observed in extensive human studies. Overall, both teriparatide and abaloparatide have demonstrated convincing clinical effectiveness and cost-effectiveness, with a reassuring safety profile. Potential differences in their effects on bone mineral density and their antifracture effects offer avenues for differentiation but require further validation in appropriately designed studies
The Cross-Cultural Ability of the Inventory of Problems-29-M (IOP-29-M) to Detect Feigned Symptom Presentations:A Replication of Akca et al. (2023) on a Romanian-Speaking Sample
No full textThis study replicated research on the ability of the Inventory of Problems-29 (IOP-29) to detect honest, feigning, and random responding, and investigated the accuracy of its memory module (IOP-M) in a Romanian-speaking sample. 127 participants, randomized into three groups, were assessed online with the IOP-29-M, in each responding condition. The standard cutoff of >=.50 on the IOP-29 False Disorders Probability Scale accurately discriminated honest from feigned protocols. The Random Responding Scale showed promise in indicating careless responding. Combining the IOP-29 FDS and IOP-M improved classification accuracies. Results support the IOP-29-M's cross-cultural validity and its utility in forensic and clinical settings