Background Successful mass vaccination programmes are public health achievements of the contemporary world. While pharmaceutical companies are actively developing new vaccines, and demonstrating results of effectiveness and safety profiles, concerns on COVID-19 vaccine management are under-reported. We aimed to synthesise the evidence for efficient cold chain management of COVID vaccines. Methods The scoping review’s conduct and reporting were based on the PRISMA–ScR 2018 checklist. We searched from April 2020 to January 2022 for publications in PubMed (LitCovid), Scopus and ScienceDirect. All review stages were pilot-tested to calibrate 2 reviewers. Articles on cold chain logistics and management were included, while publications solely describing COVID vaccines, their development and clinical aspects of the vaccine, were excluded. To capture relevant data, charting was conducted by one reviewer and verified by another. Results were analysed thematically and summarised descriptively in a table and in-text. Results and discussion We assessed 6984 potentially relevant citations. We included 14 publications originating from USA (n = 6), India (n = 2), Finland, Spain, Bangladesh, Netherlands, Switzerland and Ethiopia. They were reported as reviews (4), policy or guidance documents (3), experimental studies (2), case reports (2), expert commentary (1), phenomenological study (1), and decision-making trial and evaluation laboratory trial (1). The findings were presented in three themes: (i) regulatory requirements for cold-chain logistics, (ii) packaging and storage, and (iii) transportation and distribution. A conceptual framework emerged linking regulatory requirements, optimal logistics operation and formulation stability as the key to efficient cold chain management. Recommendations were made for improving formulation stability, end-product storage conditions, and incorporating monitoring technologies. Conclusion COVID-19 vaccines require special end-to-end supply cold chain requirements, from manufacture, and transportation to warehouses and healthcare facilities. To sustain production, minimise wastage, and for vaccines to reach target populations, an efficient and resilient vaccine supply chain which is assisted by temperature monitoring technologies is imperative.

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ObjectiveTo categorise patient-reported outcome measures (PROMs) into their propensity to detect intentional and/or unintentional non-adherence to medication, and synthesise their psychometric properties.DesignSystematic review and regression analysis.EligibilityMedication adherence levels studied at primary, secondary and tertiary care settings. Self-reported measures with scoring methods were included. Studies without proxy measures were excluded.Data sourcesUsing detailed searches with key concepts including questionnaires, reliability and validity, and restricted to English, MEDLINE, EMBASE, CINAHL, International Pharmaceutical Abstracts, and Cochrane Library were searched until 01 March 2022. Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA-2020) checklist was used.Data analysisRisk of bias was assessed via COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN-2018) guidelines. Narrative synthesis aided by graphical figures and statistical analyses.Outcome measuresProcess domains [behaviour (e.g., self-efficacy), barrier (e.g., impaired dexterity) or belief (e.g., perception)], and overall outcome domains of either intentional (I), unintentional (UI), or mixed non-adherence.ResultsPaper summarises evidence from 59 studies of PROMs, validated among patients aged 18–88 years in America, the United Kingdom, Europe, Middle East, and Australasia. PROMs detected outcome domains: intentional non-adherence, n=44 (I=491 criterion items), mixed intentionality, n=13 (I=79/UI=50), and unintentional, n=2 (UI=5). Process domains detected include belief (383 criterion items), barrier (192) and behaviour (165). Criterion validity assessment used proxy measures (biomarkers, e-monitors), and scoring was ordinal, dichotomised, or used Visual Analogue Scale. Heterogeneity was revealed across psychometric properties (consistency, construct, reliability, discrimination ability). Intentionality correlated positively with negative beliefs (r(57)=0.88) and barriers (r(57)=0.59). For every belief or barrier criterion-item, PROMs’ aptitude to detect intentional non-adherence increased by β=0.79 and β=0.34 units, respectively (R2=0.94). Primary care versus specialised care predicted intentional non-adherence (OR 1.9; CI 1.01 to 2.66).ConclusionsTen PROMs had adequate psychometric properties. Of the ten, eight PROMs were able to detect total, and two PROMs were able to detect partial intentionality to medication default. Fortification of patients’ knowledge and illness perception, as opposed to daily reminders alone, is most imperative at primary care levels.

Objectives With a shift in global demographic trends favouring the older population, depression, which is increasingly common to older adults, is fast becoming a significant public health phenomenon that can result in rising healthcare costs, co-morbidities and fatalities. In particular, challenges to prescribing antidepressants to older people given their altered pharmacodynamic and pharmacokinetic profiles is of major concern to healthcare providers. We aimed to review the challenges encountered by prescribers when diagnosing and selecting older patients suited to receive an antidepressant. Methods English articles published between 2011 and 2021 were searched from the three databases which were MEDLINE, Cochrane Library and EMBASE to identify studies related to challenges in prescribing antidepressants for older people with the combination of search keywords such as depression, antidepressants, elderly and challenges, but not limited to them. Studies were excluded if the age of the participant is below 65 years old. The relevancy of the studies to be included were examined initially based on their titles and abstracts. Additional articles were searched from the reference lists of relevant articles. Key findings Out of 2500 studies, 11 articles was included in this study. The challenges were classified into three themes: challenges associated with the ageing processes, difficulty in recognising depressive symptoms and challenges in distinguishing depression from cognitive impairment. Conclusions Antidepressant prescribing in the elderly is complicated, in which there is a lack of proof for beneficial approaches. The study highlighted pertinent challenges to prescribers when older patients seek drug therapy for depression. This could have easily led to many depression cases gone undiagnosed or misdiagnosed.