Bausch Health (Canada)

SummaryThis study examined the change in weight at 6 months of naltrexone/bupropion (NB), a combination pharmacological therapy for weight management, in real‐world practice in Canada. The study was conducted through an observational, retrospective, single‐arm chart review of adult patients who attended the Wharton Medical Clinic in Ontario, Canada, between 2018 and 2021. The patients had a body mass index ≥30 or ≥27 kg/m2 with at least one weight‐related comorbidity. They were prescribed NB, titrated from 1 (8 mg/90 mg) to 4 tablets daily, along with lifestyle modification. Approximately 52% of 468 participants completed 6 months of treatment and 48.7% titrated to the maximum dose of 4 tablets daily. Participants were mainly female, with mean age of 49.5 years and BMI 38.4 kg/m2. After 6 months, participants lost a mean of 4.23 kg (95% confidence interval [CI] −4.99, −3.47) or 4.05% (CI −4.77, −3.34) of body weight, with 42.5% losing at least 5% of their body weight and 15.5% losing at least 10%. The most frequent adverse events were nausea (5.7%), constipation (5.7%), and headache (2.5%). Participants also experienced decreased appetite (14.7%), decreased cravings (13.9%), decreased hunger (9.4%) and felt full sooner (2.5%), which are changes likely to result in sustained healthy food choices and improved quality of life. The 6‐month NB treatment adjunct to lifestyle modification in a real‐world population resulted in clinically significant weight loss.

BackgroundOzanimod is a novel immune modulator that could be useful in viral pulmonary infections by reducing lung inflammation. It is an S1P receptor ligand known to induce bradycardia and more serious adverse cardiac effects, such as atrioventricular block and QT interval prolongation. We present a substudy of the COVID-19 Ozanimod Intervention (COZI) trial in which ozanimod was administered in acute pulmonary infection patients, to assess cardiac safety. MethodsIn this pilot randomized open-label trial, COVID-19 patients requiring oxygen support were randomized into 2 groups: standard-of-care + ozanimod (OZA) vs standard-of-care alone (SOC). All patients were monitored with a 14-day electrocardiogram monitor (CardioSTAT, Icentia, Quebec, QC) during their hospitalization. We evaluated the cardiac effects of ozanimod on heart rate (HR), PR interval length, and QT interval duration. ResultsA total of 42 patients were analyzed: 23 in the SOC group and 19 in the OZA group. Mean hourly HR over the first 10 days of treatment decreased in the OZA group, compared with that in the SOC group (P < 0.0001). The maximum decrease in HR occurred on day 3. The maximum decrease in HR occurred on day 3, without a significant difference between groups: 49 beats per minute (interquartile range, 42-59) in the OZA group, and 54 beats per minute (48–60) in the SOC group, P = 0.45. No high-degree atrioventricular block was recorded. QT and PR interval median values were within the normal range in both groups, without a significant difference. ConclusionsThe maximal reduction in HR occurred 3 days after the onset of ozanimod treatment in patients hospitalized for COVID-19, but it did not remain significant over the 10-day treatment period. No relevant cardiac adverse event was observed.

In this study, we sought to analyse experiences in weight management among physicians working in the area of obesity and contrast these experiences with best practices. By understanding experiences of physicians working in obesity management, we can better support implementation of best practices in their day-to-day practice. An online survey of Canadian primary care physicians, internists and endocrinologists recruited from a nationwide market research database was conducted. The survey captured demographic characteristics and perceptions about weight loss and its management. One hundred and ninety-two physicians (140 primary care, 22 internists and 30 endocrinologists) were recruited and completed the survey. Challenges identified by the physicians in helping patients lose weight included patients' poor compliance and lack of time and resources to address the issue. Most physicians reported considering obesity to be a chronic disease, but most did not incorporate a multi-dimensional, chronic disease model of obesity treatment (i.e., combination of lifestyle interventions with psychological, medical and/or surgical interventions). Endocrinologists reported management practices consistent with a chronic disease model more frequently than primary care physicians. These data highlight the need for improvement in obesity management, particularly in primary care. Despite proliferation of guidelines on best practices, implementation of these practices into daily practice remains low.

BACKGROUNDWe aimed to evaluate the feasibility of implementing Chester, a novel web-based chest X-ray (CXR) interpretation artificial intelligence (AI) tool, in the medical education curriculum and explore its effect on the diagnostic performance of undergraduate medical students.METHODSThird-year trainees were randomized in experimental (N=16) and control (N=16) groups and stratified for age, gender, confidence in CXR interpretation, and prior experience. Participants filled a pre-intervention survey, a test exam (Exam1), a final exam (Exam2), and a post-intervention survey. The experimental group was allowed to use Chester during Exam1 while the control group could not. All participants were forbidden from using any resources during Exam2. The diagnostic interpretation of a fellowship-trained chest radiologist was used as the standard of reference. Chester’s performance on Exam1 was 60%. A five-point Likert scale was used to assess students’ perceived confidence before/after the exams as well as Chester’s perceived usefulness.RESULTSUsing a mixed model for repeated measures (MMRM), it was found that Chester did not have a statistically significant impact on the experimental group’s diagnostic performance nor confidence level when compared to the control group. The experimental group rated Chester’s usefulness at 3.7/5, its convenience at 4.25/5, and their likelihood to reuse it at 4.1/5.CONCLUSIONOur experience highlights the interest of medical students in using AI tools as educational resources. While the results of the pilot project are inconclusive for now, they demonstrate proof of concept for a repeat experiment with a larger sample and establish a robust methodology to evaluate AI tools in radiological education. Finally, we believe that additional research should be focused on the applications of AI in medical education so students understand this new technology for themselves and given the growing trend of remote learning.

To the Editor: Halobetasol propionate 0.01%/tazarotene 0.045% lotion (HP/TAZ) was developed as an effective, safe, and tolerable topical therapy for plaque psoriasis. It has been investigated in moderate-to-severe plaque psoriasis1-3; however, real-world data on the use of topical fixed-combination therapies for plaque psoriasis, particularly milder disease courses, are limited.

Acupuncture is generally considered safe; however, cardiac complications can occur. We describe a case of refractory pericarditis requiring transvenous extraction of an acupuncture needle from within the right ventricular cavity. (Level of Difficulty: Intermediate.)