Pharmacy doi: 10.3390/pharmacy13040107

Authors: Tijana Kova?evi? Sonja Nedini? Vedrana Bari?i? Branislava Miljkovi? Emir Fazli? Slobodan Vukadinovi? Pedja Kova?evi?

Medication discrepancies at hospital admission are common and may lead to adverse outcomes. Medication reconciliation is a critical process for minimizing medication discrepancies and medication errors at the time of hospital admission. This study aimed to evaluate the role of clinical pharmacists in identifying pharmacotherapy-related issues upon patient admission in a low-resource setting. A prospective observational study was conducted at a university hospital between 1 March and 31 May 2023. Within 24 h of admission, a clinical pharmacist documented each patient’s pre-admission medication regimen and compared it with the medication history obtained by the admitting physician. Discrepancies and pharmacotherapy problems were subsequently identified. Among 65 patients, pharmacists documented 334 medications versus 189 recorded by physicians (p < 0.01). The clinical pharmacist identified 155 discrepancies, 112 (72.26%) of which were unintentional. The most frequent type was drug omission (91.07%), followed by incorrect dosage (4.46%), incorrect dosing interval (2.68%), and medications with unknown indications (1.79%). Most discrepancies were classified as errors without harm (53.57%), while 41.07% were potentially harmful. These findings underscore the importance of integrating clinical pharmacists into the healthcare team. Their active participation during hospital admission can significantly enhance medication safety and reduce preventable adverse drug events.

Pharmacy doi: 10.3390/pharmacy13040106

Authors: Eloy del Río

Osteoarthritis (OA) remains a major contributor to pain and disability; however, the current management is largely reactive, focusing on symptoms rather than preventing irreversible cartilage loss. This review first examines the mechanistic foundations for pharmacological chondroprotection—illustrating how conventional agents, such as glucosamine sulfate and chondroitin sulfate, can potentially restore extracellular matrix (ECM) components, may attenuate catabolic enzyme activity, and might enhance joint lubrication—and explores the delivery challenges posed by avascular cartilage and synovial diffusion barriers. Subsequently, a practical “What–How–When” framework is introduced to guide community pharmacists in risk screening, DMOAD selection, chronotherapeutic dosing, safety monitoring, and lifestyle integration, as exemplified by the CHONDROMOVING infographic brochure designed for diverse health literacy levels. Building on these strategies, the P4–4P Chondroprotection Framework is proposed, integrating predictive risk profiling (physicians), preventive pharmacokinetic and chronotherapy optimization (pharmacists), personalized biomechanical interventions (physiotherapists), and participatory self-management (patients) into a unified, feedback-driven OA care model. To translate this framework into routine practice, I recommend the development of DMOAD-specific clinical guidelines, incorporation of chondroprotective chronotherapy and interprofessional collaboration into health-professional curricula, and establishment of multidisciplinary OA management pathways—supported by appropriate reimbursement structures, to support preventive, team-based management, and prioritization of large-scale randomized trials and real-world evidence studies to validate the long-term structural, functional, and quality of life benefits of synchronized DMOAD and exercise-timed interventions. This comprehensive, precision-driven paradigm aims to shift OA care from reactive palliation to true disease modification, preserving cartilage integrity and improving the quality of life for millions worldwide.

Pharmacy doi: 10.3390/pharmacy13040105

Authors: Nardine Nakhla Ashok Hospattankar Kamran Siddiqui Mary Barna Bridgeman

Hemorrhoidal disease remains a prevalent yet often overlooked condition, affecting millions worldwide and imposing a substantial healthcare burden. Despite the availability of multiple treatment options, gaps persist in patient education, early symptom recognition, and optimal treatment selection. Recent advancements are evolving the pharmacist’s role in hemorrhoid management beyond traditional over-the-counter (OTC) and prescription approaches. The 2024 American Society of Colon and Rectal Surgeons (ASCRS) guidelines introduce updates on the use of phlebotonics, a class of venoactive drugs gaining recognition for their role in symptom management, yet largely underutilized in U.S. clinical practice. In parallel, novel clinical tools are reshaping how pharmacists engage in assessment and care. The integration of digital decision-support platforms and structured evaluation algorithms now empowers them to systematically evaluate symptoms, identify red flag signs, and optimize patient triage. These tools reduce diagnostic variability and improve decision-making accuracy. Given their accessibility and trusted role in frontline healthcare, pharmacists are well-positioned to bridge these critical gaps by adopting emerging treatment recommendations, leveraging algorithm-driven assessments, and reinforcing best practices in patient education and referral. This narrative review aims to equip pharmacists with updated insights into evidence-based hemorrhoid management strategies and provide them with structured assessment algorithms to standardize symptom evaluation and treatment pathways. By integrating these innovations, pharmacists can enhance treatment outcomes, promote patient safety, and contribute to improved quality of life (QoL) for individuals suffering from hemorrhoidal disease.

Pharmacy doi: 10.3390/pharmacy13040104

Authors: Bernadette Cornelison David R. Axon Bryan Abbott Carter Bishop Cindy Jebara Anjali Kumar Kristen A. Root

As artificial intelligence (AI) becomes increasingly utilized to perform tasks requiring human intelligence, patients who are pregnant may turn to AI for advice on over-the-counter (OTC) medications. However, medications used in pregnancy may pose profound safety concerns limited by data availability. This study focuses on a chatbot’s ability to accurately provide information regarding OTC medications as it relates to patients that are pregnant. A prospective, descriptive design was used to compare the responses generated by the Chat Generative Pre-Trained Transformer 3.5 (ChatGPT-3.5) to the information provided by UpToDate®. Eighty-seven of the top pharmacist-recommended OTC drugs in the United States (U.S.) as identified by Pharmacy Times were assessed for safe use in pregnancy using ChatGPT-3.5. A piloted, standard prompt was input into ChatGPT-3.5, and the responses were recorded. Two groups independently rated the responses compared to UpToDate on their correctness, completeness, and safety using a 5-point Likert scale. After independent evaluations, the groups discussed the findings to reach a consensus, with a third independent investigator giving final ratings. For correctness, the median score was 5 (interquartile range [IQR]: 5–5). For completeness, the median score was 4 (IQR: 4–5). For safety, the median score was 5 (IQR: 5–5). Despite high overall scores, the safety errors in 9% of the evaluations (n = 8), including omissions that pose a risk of serious complications, currently renders the chatbot an unsafe standalone resource for this purpose.

Pharmacy doi: 10.3390/pharmacy13040103

Authors: Javeria Khalid Tarilate Temedie-Asogwa Marjan Zakeri Sujit S. Sansgiry

Adverse drug reactions (ADRs) significantly affect patient safety and healthcare spending worldwide. Hospital pharmacists are uniquely positioned to address ADRs due to their crucial role in medication management. However, underreporting remains a global concern, especially in developing countries, where pharmacovigilance systems are inadequately developed. Therefore, this pilot study aimed to evaluate and compare the knowledge, attitudes, perceived barriers, and facilitators regarding ADR reporting by hospital pharmacists in a developed (US) and a developing (Pakistan) country. A cross-sectional survey was conducted, using a pre-validated questionnaire. The pharmacists, possessing a minimum of one year’s hospital experience, were selected via convenience sampling. Out of 151 respondents, included in the final analysis (US: n = 51; Pakistan: n = 100), the majority were female (62.3%), aged 29–35 years (38%), and possessed a Pharm. D degree (49.7%). The knowledge (US: 6.03 ± 0.27 vs. Pakistan:5.69 ± 0.25, p-value = 0.193) and attitude scores (US: 32.02 ± 0.73 vs. Pakistan: 32.63 ± 0.67; p-value = 0.379) exhibited no significant differences between the groups. Nonetheless, barriers at both the individual and systemic levels were more pronounced in the developing country. Important facilitators reported were mobile applications for ADR reporting, specialized training, and intuitive reporting tools. In conclusion, we found that pharmacists in both settings exhibit comparable knowledge and positive attitudes towards ADR reporting, though specific contextual barriers are present. Interventions customized to the local hospital infrastructure are crucial for enhancing ADR reporting, particularly in resource-constrained settings.

Pharmacy doi: 10.3390/pharmacy13040102

Authors: Maria Cordina Mary Anne Lauri Josef Lauri

The uptake of the COVID-19 and seasonal influenza (SI) vaccines have decreased in Europe and especially in Malta. The present study aimed to investigate the attitudes toward COVID-19 and SI vaccines and determine if individuals perceive that these vaccines are relevant to protect their health and identify reasons for their responses. A cross-sectional study using an anonymous questionnaire, informed by the Theory of Planned Behavior, addressing behavior beliefs and attitudes, and targeted at adult residents in Malta, was designed on Google Forms and disseminated using social media between January and March 2024. A total of 555 responses were received. The majority of respondents did not take/intend to take the COVID-19 (75%, n = 417) or SI (64.3%, n = 362) vaccines, with females being less likely to do so (p = 0.033). Perceived lack of safety (31.3%, n = 174) was the primary reason for rejecting the COVID-19 vaccine, and perceived lack of a threat from SI (26%, n = 144) was the reason for rejecting the SI vaccine. Those having chronic conditions were positively associated with uptake of both vaccines. In the post-pandemic era, these vaccines are not envisaged as having a major role in protecting one’s health. A high degree of skepticism especially toward the combined COVID-19 and SI vaccine in terms of safety, mostly in women, is still present.

Pharmacy doi: 10.3390/pharmacy13040101

Authors: Nanayakkara Muhandiramalaya Yasa Kalum Bagyawantha Isuri Nilnuwani Dangahage Ghanamoorthy Mayurathan Weerasinghe Mudiyanselage Suminda Pushpika

Heart failure is a chronic disease with significantly high morbidity and mortality rates, and a thorough understanding of medication adherence and appropriateness is crucial to ensure effective treatment outcomes. This cross-sectional observational study aimed to assess medication adherence, understand the influence of sociodemographic factors on medication adherence, and assess the medication appropriateness for heart failure patients attending the cardiac clinic at National Hospital Kandy (NHK). This study was conducted among 325 heart failure patients attending the cardiac clinic at the NHK. Medication adherence was assessed using the brief medication questionnaire (BMQ) after detailed medication history interviews. Statistically significant associations between total BMQ scores and sociodemographic factors were determined at 95% confidence interval. The appropriateness of the newly prescribed medication lists was assessed using the medication appropriateness index (MAI). Among the 325 patients recruited, the mean total BMQ score was 1.16; 11.7% of the participants were adherent to their medications whereas 15.4% had poor adherence. Most participants (52.0%) were in the probable poor adherent level. Statistically significant associations were observed between total BMQ score and age, sex, and education level. The mean MAI score was 0.56. Medication adherence among heart failure patients was poor and some sociodemographic factors influenced medication adherence. The appropriateness of prescribed medications was found to be acceptable.

Pharmacy doi: 10.3390/pharmacy13040100

Authors: Jennifer Cerulli Alisha Roberts Ellie Wilson Scott Guisinger

A total of 38% of Americans do not meet the Recommended Dietary Allowance (RDA) for calcium including those at risk for osteoporosis. To increase the percentage of patients at risk for osteoporosis who achieve goal calcium RDA intake, a collaborative specialty pharmacy-registered dietitian-nutritionist (RDN) quality improvement program was developed. Patients aged 18 to 90 years old receiving osteoporosis therapy (denosumab, teriparatide, zoledronic acid) or medications that increase bone loss (elagolix, oral prednisone) were provided with a structured assessment and educational intervention. Daily calcium intake included patient self-reported dietary intake plus supplement use. Written and verbal education on increasing dietary intake based on patient preferences was provided with 5 calcium-rich food-source store coupons. Recommendations for supplement selection (citrate vs. carbonate) and/or medication-related problem resolution were provided. Follow-up occurred at 3–6 months. Fifty patients enrolled [94% female, mean age 66.6 years (SD 15.3)] were taking denosumab (36), teriparatide (1), zoledronic acid (1), elagolix (7) and prednisone (5). The mean baseline daily dietary calcium intake was 500 mg (SD 247) with none achieving goal intake with diet alone. Average calcium supplement use in 22 (44%) patients was 686 mg daily (SD 284). At baseline, 17 (34%) met goal daily calcium intake compared to 30 (60%) at post intervention follow-up (p = 0.009). Over half of the store coupons were redeemed. A specialty pharmacy-RDN customized intervention program provides a model for aiding patients to modify calcium intake.

Pharmacy doi: 10.3390/pharmacy13040099

Authors: Courtney E. Gamston Salisa C. Westrick Mafe Zmajevac Jingjing Qian Greg Peden Dillon Hagan Kimberly Braxton Lloyd

Pharmacist-led transitions of care (TOC) services decrease preventable hospital readmission. TOC service implementation assessment can inform translation to real-world settings. The purpose of this study was to evaluate the implementation of a TOC service for patients with multiple admissions at a regional hospital using the RE-AIM framework. In this quasi-experimental, non-randomized study, individuals with ≥2 recent hospitalizations received pharmacist-led discharge medication reconciliation and counseling, management of drug-related problems, post-discharge telephonic visits, and social support. The reach, effectiveness, implementation, and maintenance RE-AIM dimensions were assessed using patient and service records. Outcomes included 30-day readmission rates for individuals completing ≥1 outpatient pharmacist visit (intervention) versus those unreachable in the outpatient setting (comparison), completed interventions, implementation features, and service adaptations. Chi-square and Fisher’s exact tests were used for comparison of categorical variables and the t-test was used for continuous variables. From February 2022 to August 2023, 72.7% of the 66 service participants participated in the intervention (reach). Additionally, 30-day readmission was 22.9% (intervention) versus 55.6% (comparison; p = 0.01). In total, 2279 interventions were documented (effectiveness). The service was adapted (implementation) and expanded to include additional populations (maintenance) to enhance sustainability. Based on RE-AIM evaluation, the pharmacist-led TOC intervention appears to be a sustainable solution for addressing readmission in multivisit patients.

Pharmacy doi: 10.3390/pharmacy13040098

Authors: Paula S. C. C. Castro Kae Leopoldo Maria Olivia Pozzolo Pedro Juliana Takitane Henrique Silva Bombana André Brooking Negr?o Jaqueline R. Scholz Jo?o Maurício Castaldelli-Maia

Objective: To systematically review the scientific literature on lysergic acid amide (LSA), focusing on its physical, neurobiological, and social effects, as well as its potential risks and therapeutic uses. Methods: A systematic review was conducted across PubMed, Google Scholar, and Web of Science up to December 2023, using keywords such as “ergine,” “lysergic acid amide,” and “legal high.” Studies were included if they reported original human data on the physical, neurobiological, psychological, or social effects of LSA; seventeen studies were included. Animal studies, in vitro research, and non-original articles were excluded. Two independent reviewers screened and selected the studies, with a third resolving discrepancies. Data were extracted using a standardized form. The review followed PRISMA guidelines and was prospectively registered on the Open Science Framework. Results: LSA is primarily consumed through preparations made from the seeds of Convolvulaceae plants. Reported effects include euphoria, hallucinations, nausea, and anxiety. Severe adverse outcomes, such as psychosis, hypertension, and hospitalization, have also been documented. Some evidence suggests its potential therapeutic application for cluster headaches. However, variability in dosing and misinformation on digital platforms heighten the risks associated with LSA use. Conclusions: LSA poses significant health risks, exacerbated by online misinformation and variability in its effects, and a lack of scientific studies. Further research is essential to clarify its pharmacological profile, establish guidelines for safe use, and raise public awareness about its dangers.

Pharmacy doi: 10.3390/pharmacy13040097

Authors: Yuyao Pei Ruoxin Huang Feng Chang Yuanhui Hu Sarah Versteeg Yufen Zheng

(1) Background: Patient-centered care for individuals with breast cancer requires multidisciplinary cooperation to ensure the appropriate use of medication and prevent medication-related problems. Pharmaceutical care has been associated with improved adherence in breast cancer management, a factor linked to patient outcomes and mortality. This study aims to summarize and explore the provision and utilization of pharmaceutical services for breast cancer patients by pharmacists. (2) Methods: A scoping review was performed to assess the pharmacist’s role in providing pharmaceutical services for patients with breast cancer. A comprehensive review of four databases (PubMed, Ovid Embase, Ovid International Pharmaceutical Abstracts, and Scopus) was completed between 1 January 2012 and 8 April 2025 according to PRISMA-ScR framework. (3) Results: A total of 46 articles met the inclusion criteria, which included RCTs, observatory studies, cohort studies, and reviews. Findings suggest that both clinical and community pharmacists play an important role in prevention, management, and education for breast cancer patients. (4) Conclusions: Pharmacists can improve health outcomes by providing pharmaceutical service in breast cancer care. Optimizing interventions, expanding services, and evaluating long-term cost-effectiveness is needed in the future.

Pharmacy doi: 10.3390/pharmacy13040096

Authors: Mitchell L. Doucette Emily Fisher Junella Chin Panagiota Kitsantas

Introduction: Chronic pain affects approximately 20% of U.S. adults, imposing significant burdens on individuals and healthcare systems. Medical cannabis has emerged as a potential therapy, yet its impact on healthcare utilization remains unclear. Methods: This retrospective cohort study analyzed administrative data from a telehealth platform providing medical cannabis certifications across 36 U.S. states. Patients were classified as cannabis-exposed if they had used cannabis in the past year, while unexposed patients had no prior cannabis use. Outcomes included self-reported urgent care visits, emergency department (ED) visits, hospitalizations, and quality of life (QoL), measured using the CDC’s Healthy Days measure. Targeted Maximum Likelihood Estimation with SuperLearner estimated causal effects, adjusting for numerous covariates. Results: Medical cannabis users exhibited significantly lower healthcare utilization. Specifically, exposure was associated with a 2.0 percentage point reduction in urgent care visits (95% CI: −0.036, −0.004), a 3.2 percentage point reduction in ED visits (95% CI: −0.051, −0.012) and fewer unhealthy days per month (−3.52 days, 95% CI: −4.28, −2.76). Hospitalization rates trended lower but were not statistically significant. Covariate balance and propensity score overlap indicated well-fitting models. Conclusions: Medical cannabis use was associated with reduced healthcare utilization and improved self-reported QoL among chronic pain patients.

Pharmacy doi: 10.3390/pharmacy13040095

Authors: Hristina Lebanova Vesselina Yanachkova Svetoslav Stoev

Polycystic ovary syndrome (PCOS) is an endocrine disorder prevalent in women of reproductive age, often requiring complex pharmacological management. The heterogeneity of the syndrome and the use of on- and off-label therapeutic agents—ranging from insulin sensitizers and ovulation inducers to oral contraceptives and herbal supplements—pose significant challenges, including adverse effects, drug interactions, and poor adherence. This narrative review explores the role of pharmacists in identifying and mitigating drug-related problems (DRPs) associated with PCOS therapy. Through thematic synthesis of the current literature, the study highlights common DRPs such as suboptimal drug selection, inappropriate dosing, prolonged therapy duration, and treatment-related safety concerns. It underscores the value of pharmacists’ interventions in enhancing medication adherence, optimizing therapeutic regimens, providing patient education, and monitoring adverse events. A structured, patient-level pharmaceutical care model is proposed, emphasizing personalized assessment, interdisciplinary collaboration, and continuous follow-up. The integration of clinical pharmacists into PCOS care teams has the potential to improve treatment effectiveness, patient satisfaction, and long-term health outcomes. Pharmacists’ contributions are especially critical given the widespread use of off-label therapies and supplements with variable evidence of benefit. Tailored pharmaceutical care can thus bridge the existing gaps in PCOS management and enhance the quality of life for the affected individuals.

Pharmacy doi: 10.3390/pharmacy13040094

Authors: Annesha White Erika L. Thompson Solyi Kim Janice A. Osei Kimberly G. Fulda Yan Xiao

Preventable adverse drug events (ADEs) remain a significant threat in community settings, a challenge that is critical in community pharmacy settings where continuity of care and healthcare access can be limited. This qualitative study explored the perspectives of 13 community pharmacists through focus groups and interviews to identify barriers and propose solutions to enhance their role in patient care. Pharmacists emphasized their critical position in ensuring safe medication use, particularly for older adults managing multiple chronic conditions. Key findings revealed five themes: (1) defining medication safety as minimizing risk and empowering patients; (2) characteristics of the “perfect patient,” including medication awareness and proactive engagement; (3) the pharmacist’s role in detecting and resolving medication-related problems; (4) systemic barriers such as time constraints, lack of access to patient records, insufficient privacy, and undervaluation of pharmacists’ roles; and (5) proposed solutions including private counseling areas, increased staffing, integrated electronic health records, and legislative recognition of pharmacists as healthcare providers. Strengthening collaboration with physicians and empowering patients through education were also highlighted as key strategies. These findings underscore the need for systemic changes—especially in light of lessons learned during the pandemic—to support pharmacists in delivering comprehensive medication management and improving patient safety.

Pharmacy doi: 10.3390/pharmacy13040093

Authors: Chinemerem Opara Annesha White Kimberly G. Fulda Somer Blair Clare Aduwari Nihitha Nukala Yan Xiao

The COVID-19 pandemic disrupted routine care for individuals with type 2 diabetes mellitus (T2DM), raising concerns about its impact on glycemic control and medication management. This study evaluated the relationship between insulin use and glycemic control among T2DM patients during the pandemic. A retrospective analysis was conducted using deidentified clinical and prescription data from two family medicine clinics, comparing data from the pre-COVID-19 period (1 March 2019–13 March 2020) and during the COVID-19 pandemic (14 March 2020–31 March 2021). Patients included had at least two A1c values before the COVID and one during the COVID. A1c control was defined as less than 8%. Among 992 patients, 238 experienced a change in A1c status: 128 improved and 110 worsened. Mean A1c remained stable at 8.2 across both periods. A majority of patients who improved were using insulin during the COVID-19 era, although some discontinued insulin at some point during the study period. These findings suggest that consistent insulin therapy may have helped maintain glycemic control despite healthcare disruptions. This study highlights the importance of sustained medication management and suggests that integrating telehealth and pharmacist-led care could support diabetes control during future healthcare system challenges.

Pharmacy doi: 10.3390/pharmacy13040092

Authors: Sean Hyungwoo Kim Hua Min Hong Xue Panagiota Kitsantas

Polysubstance use (PSU) involving marijuana among women of reproductive age (WRA) is linked to psychosocial harm, yet research on the combined effects of marijuana with stimulants, opioids, tobacco, and binge drinking remains limited. The purpose of this study was to assess the prevalence of PSU in WRA with past month MJ use and examine the association between PSU status and social sequelae, including getting in trouble with the law, relationship difficulty with others, and lower achievement in job or educational settings, in this group of women. We used data from the United States 2015–2019 National Survey on Drug Use and Health, which included 11,895 non-institutionalized WRA (18–44 years old) with reported use of MJ in the past month. Descriptive statistics, chi-squared tests, and multivariable logistic regression analyses were conducted to describe the sample and assess associations between PSU and social sequelae. Nearly 4.5% of the women who used MJ in the past month had experienced social sequelae regardless of PSU status. Women who used three or more substances along with MJ had the highest adjusted odds (AOR = 3.18, 95% CI 1.90, 5.31) of social sequelae relative to monosubstance MJ users. Concurrent use of multiple substances significantly increased the likelihood of social sequelae among women MJ users.

Pharmacy doi: 10.3390/pharmacy13040091

Authors: Irene García-Domínguez Azahara Rodríguez-Luna Manuel Machuca

Relational pharmacology introduces an innovative approach using visual thinking to understand how drugs interact with multiple body systems, addressing the limitations of the traditional “reductionist approach”. While conventional pharmacology focuses on individual drug effects, it struggles with the complexities of polypharmacy, where multiple medications interact via shared metabolic pathways. This article highlights integrating systemic maps into educational methodologies to empower students in identifying and assessing medication risks. By visualizing the body and drug therapy as interconnected systems, students can better understand complex pharmacological interactions beyond linear frameworks. This approach enables active learning and real-life case analysis, such as cardiovascular prevention with non-selective antidepressants, where multiple drug interactions must be considered. It also fosters global health education by promoting the exchange of effective teaching practices and addressing challenges in healthcare training. Systemic maps prepare students for clinical decision-making by enhancing their ability to manage risks and complex cases effectively.

Pharmacy doi: 10.3390/pharmacy13040090

Authors: Xue Wang Yinfeng Wang Xiaomeng Zhang Bing Zhang Zhijian Lin

The definition of pharmacovigilance was first proposed in the 1970s to safeguard public health and the safety of drug use, and to improve the quality of life of patients. China’s traditional medicine has also always contained the idea of vigilance for the safe use of medicines in the process of development. In this article, we will discuss the origin and development of the idea of pharmacovigilance in China, the establishment of a realistic system, and the current status of pharmacovigilance construction, and look forward to the development of pharmacovigilance in the future.

Pharmacy doi: 10.3390/pharmacy13040089

Authors: Harshita Patel Myles Wee Aaron M. Tejani Anthony Lau

Background: The role of clinical pharmacists in the emergency department continues to gain recognition, particularly during cardiac and trauma resuscitations. However, their contributions to patient outcomes remain unclear. The objective of this scoping review with narrative synthesis was to determine the impact of pharmacists on medication and patient outcomes during cardiac and trauma resuscitations and to identify barriers to integration. Methods: A literature search of databases in September 2024 identified randomized and non-randomized control trials, evaluating the impact of pharmacists’ involvement in cardiac or trauma resuscitations. Excluded were studies on acute stroke, acute hemorrhage, and sepsis. Data were extracted and analyzed for primary (e.g., medication errors and Advanced Cardiovascular Life Support [ACLS] compliance) and secondary outcomes (e.g., pharmacists’ education and training). Results: Of the 560 records screened, 26 records were included in the final analysis. Due to heterogeneity, quantitative analysis was not feasible. Among primary outcomes, ACLS guideline compliance and medication errors were commonly reported; mortality and length of stay were less commonly reported. ACLS certification improved pharmacists’ confidence in their tasks. Pharmacists’ presence also correlated with reduced healthcare costs. Conclusions: Our analysis suggests that the involvement of pharmacists in the context of emergency cardiac or trauma resuscitations may benefit direct patient outcomes and indirect outcomes.

Pharmacy doi: 10.3390/pharmacy13030088

Authors: Anna Mihaylova Antoniya Yaneva Dobromira Shopova Petya Kasnakova Stanislava Harizanova Nikoleta Parahuleva Rumyana Etova Ekaterina Raykova Mariya Semerdzhieva Desislava Bakova

Advances in pharmaceutical technology have positioned 3D printing and bioprinting as promising tools for developing personalized drug therapies. These innovations may redefine compounding practices by enabling precise, patient-specific drug formulations. Evaluating pharmacists’ readiness to adopt such technologies is therefore becoming increasingly important. Aim: The aim of this study is to investigate pharmacists’ knowledge, attitudes, and perceived barriers regarding the application of 3D printing and bioprinting technologies, as well as their perspectives on the regulation and implementation of these technologies in the context of personalized pharmacy. Materials and Methods: A custom-designed questionnaire was developed for the purposes of this pilot study, based on a review of the existing literature and informed by expert consultation to ensure conceptual relevance and clarity. The survey was conducted between September and December 2024. The data collection instrument comprises three main sections: (1) sociodemographic and professional characteristics, (2) knowledge regarding the applications of 3D printing and bioprinting in pharmacy, and (3) attitudes toward the regulatory framework and implementation of these technologies. Results: A total of 353 respondents participated, and 65.5% of them (n = 231) correctly distinguished between the concepts of “3D printing” and “bioprinting.” More than 25% (n = 88) were uncertain, and 8.5% (n = 30) were unable to differentiate between the two. Regarding the perceived benefits of personalized pharmacy, 83% (n = 293) of participants identified “the creation of personalized medications tailored to individual needs” as the main advantage, while 66% (n = 233) highlighted the “optimization of drug concentration to enhance therapeutic efficacy and minimize toxicity and adverse effects.” Approximately 60% (n = 210) of the pharmacists surveyed believed that the introduction of 3D-bioprinted pharmaceuticals would have a positive impact on the on-site preparation of customized drug formulations in community and hospital pharmacies. Lack of regulatory guidance and unresolved ethical concerns were identified as primary barriers. Notably, over 40% (n = 142) of respondents expressed concern that patients could be subjected to treatment approaches resembling “laboratory experimentation.” Nearly 90% (n = 317) of participants recognized the need for specialized training and expressed a willingness to engage in such educational initiatives. Conclusions: Three-dimensional printing and bioprinting technologies are considered cutting-edge instruments that may contribute to the advancement of pharmaceutical practice and industry, particularly in the field of personalized medicine. However, respondents’ views suggest that successful integration may require improved pharmacist awareness and targeted educational initiatives, along with the development and adaptation of appropriate regulatory frameworks to accommodate these novel technologies in drug design and compounding.

Pharmacy doi: 10.3390/pharmacy13030087

Authors: Dalal Salem Bakheit Aldossari Naeema Taha Alshalaan Khuloud Salem Alshammari Fatima Ahmed Lubbad Mudhi Ratyan Alanazi Neamah Ahmed Lubbad Nada Suliman Fahad Alessa Sheraz Ali

Background and objectives: As part of Vision 2030, Saudi Arabia aims to strengthen its healthcare system by enhancing efficiency, reducing medical errors, and ensuring drug safety. Evidence on pharmacists’ experiences with adverse drug reactions (ADRs) in daily practice remains limited. Gaining insight into their perspectives is essential for improving patient safety and optimizing pharmaceutical care. Therefore, we aimed to assess pharmacists’ ability to identify ADRs in daily practice and the subsequent actions taken upon identification. Methods: Between July and August 2024, an email-based invitation was sent to randomly selected registered community and hospital pharmacists in Saudi Arabia to participate in the study, which employed a piloted questionnaire. Results: The study involved 305 pharmacists, including 169 hospital/clinical pharmacists (HCPs, 55.4%) and 136 community pharmacists (CPs, 44.6%). A majority (n = 251, 82.3%) indicated direct patient encounters, while 67.2% (n = 205) reported observing suspected ADRs in the preceding 12 months. Most respondents filed ADR reports to the Saudi Food and Drug Administration/National Pharmacovigilance Centre (HCP = 103, CP = 60) and hospital drug information centers (HCP = 89, CP = 64), with online forms being the favored mode (HCP = 122, CP = 96). Awareness of ADR reporting procedures was reported by 128 HCPs and 80 CPs. Conclusions: More than two-thirds of participants reported having participated in ADR reporting, with greater adherence observed in hospital settings. Pharmacists predominantly depend on the Saudi Food and Drug Administration/National Pharmacovigilance Centre and hospital drug information centers for reporting, with a preference for online submission methods. Targeted educational interventions addressing gaps in knowledge, reporting procedures, and form complexity could improve ADR reporting practices. These findings support the need for structured training and policy measures to strengthen pharmacovigilance system.

Pharmacy doi: 10.3390/pharmacy13030086

Authors: Saeed Barzegari Hosein Rostamian Ehsan Firoozi-Majd Ibrahim Arpaci

Iron overload is a significant concern for patients with thalassemia and often necessitates the use of iron-chelating agents to mitigate the associated complications. Selecting the most appropriate chelation therapy from the available options is a complex decision for healthcare professionals. To support this decision-making process, this study investigates the application of the “Fuzzy Analytic Hierarchy Process” (FAHP) for medication selection in thalassemia patients requiring iron-chelation therapy. In this study, 20 hematologists participated, and matrices related to the FAHP model were used to evaluate three primary iron chelators: deferoxamine, deferasirox, and deferiprone. The results revealed that deferiprone was the most effective choice, while deferasirox outperformed the others in terms of cost and patient satisfaction. Notably, deferoxamine exhibits the highest rate of side effects, followed by deferiprone and deferasirox. The results obtained from the FAHP analysis indicated a consensus among experts and highlighted deferasirox as the optimal choice for treating chronic iron overload in thalassemia patients. The study demonstrates the practical applicability of the FAHP methodology in guiding informed decisions for iron-chelation therapy. It provides insights to help healthcare professionals optimize treatment strategies for patients with thalassemia.

Pharmacy doi: 10.3390/pharmacy13030085

Authors: Murtada Alsaif Zo? Blumer

Background/Objectives: Long-acting insulin glargine (iGlar) has been available as a biosimilar since 2014 in the UK. We reviewed previous prescribing to evaluate if the anticipated cost savings with biosimilars were realized with iGlar. Methods: This study investigated prescribing patterns of long-acting iGlar (100 units/mL) in cartridges and pre-filled pens from 2020 to 2024 across primary care organizations in England, Northern Ireland, Scotland, and Wales. Results: iGlar prescribing declined in all of the four nations. From 2020 to 2024, the total prescribed quantity of biosimilars persistently increased in all countries, reaching 24% in England, 5% in Northern Ireland, 24% in Scotland, and 11% in Wales, all in 2024. Consequently, the proportion of Lantus prescriptions (as quantity) decreased but continued to exceed that of all available iGlar products combined in all countries in all years analyzed. By 2024, Lantus was also priced lower than the most common biosimilar, Abasaglar, across all nations. Conclusions: The introduction of biosimilars does not automatically result in altered prescribing practices, though we show that the most commonly prescribed iGlar was also the least expensive product at the end of the analysis period. At launch and for several years after, biosimilars failed to gain strong utilization, despite cost advantages, highlighting the need for active switching policies and prescriber engagement.

Pharmacy doi: 10.3390/pharmacy13030084

Authors: Shouq Turkistani Atika AlHarbi Mansoor Khan Aeshah AlAzmi Sultan Almutairi Naglla Elimam Sultan Alotaibi

Sickle cell disease (SCD) affects millions globally, with approximately 0.26% of the Saudi population impacted. Despite standard treatments, patients frequently experience vaso-occlusive crises (VOCs). This retrospective observational study evaluated the real-world effectiveness of L-glutamine (Endari?) in reducing SCD-related complications in the Saudi population, where data remain limited. Patients aged five and older who received L-glutamine from June 2019 to June 2023 were included. The primary endpoint was VOC frequency through week 48. Descriptive statistics and paired t-tests compared outcomes before and after treatment. Fifteen patients (median age 12 years, 53% female) met the inclusion criteria; all were on maximum tolerated hydroxyurea. Eleven completed 48 weeks, showing a median VOC reduction from 4 to 3 (p = 0.44). Hospital stay duration remained unchanged (median 7 days, p = 0.72). Laboratory parameters were largely stable, except for a 61.9% increase in reticulocyte count (p = 0.03). The estimated annual treatment cost exceeded SAR 2 million (USD ~547,840). L-glutamine did not produce statistically significant improvements in VOC frequency, though numerical trends were observed. Given the small sample size and limited statistical power, the findings are exploratory. Larger, well-powered, multicenter studies are needed to confirm L-glutamine’s potential benefits in this population.

Pharmacy doi: 10.3390/pharmacy13030083

Authors: Tamather Almandeel Mansoor Ahmed Khan Ashwag Algethami Mashael S. Alaboud Munirah A. Alkathiri Mohammed Aseeri Ahmed Absi Mubarak Almansour Abdullah Alotaibi

Background: Biosimilar versions of rituximab have similar safety and efficacy as the reference product across all indications based on the extrapolation principle. Our organization replaced intravenous (IV) rituximab (Mabthera) with IV rituximab (Truxima-Biosimilar) in 2021. Hence, our practice changed to providing first cycles of IV rituximab (Truxima-Biosimilar) instead of rituximab (Mabthera), and if the first cycle was completed without severe infusion-related reactions (IRRs), then subsequent cycles were given with subcutaneous (SC) rituximab as per institutional guidelines. However, the safety of this approach has not been evaluated. Methods: A retrospective study was conducted at the Princess Nourah Oncology Center in Saudi Arabia. The primary objective was to assess IRRs after using IV rituximab (Truxima-Biosimilar) in the first cycle followed by SC rituximab in subsequent cycles. Results: Of the 71 patients reviewed, 35 patients met the eligibility criteria. Only one (3%) patient developed an IRR. However, it was a Grade 1 IRR, as per CTCAE.V5, and the patient was able to complete the remaining IV infusion successfully. Hence, all patients transitioned from IV rituximab biosimilar to SC rituximab Mabthera. Conclusions: This real-world study demonstrates that transitioning from IV rituximab biosimilar to SC Mabthera is a well-tolerated and safe practice, confirming the extrapolation principle of biosimilars.

Pharmacy doi: 10.3390/pharmacy13030082

Authors: Rishabh Sharma Linda Lee Feng Chang Tejal Patel

Potentially inappropriate medications (PIMs) increase the risk of adverse drug reactions, hospitalizations, and worsened health outcomes in older adults, particularly those with cognitive impairment (CI) or dementia. This study was designed to compare the Beers Criteria® 2023 and the Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions (STOPP) Criteria 2023 to determine which identifies a higher prevalence of PIMs in older adults with CI or dementia attending primary care-based memory clinics. PIMs were identified with the use of the updated Beers Criteria® 2023 and STOPP Criteria 2023, from electronic medical records of study participants from January to August 2023. The study identified PIMs and analyzed associated risk factors using bivariate logistic regression. Of 44 older adults, 47.7% (n = 21) were detected with one PIM based on Beers Criteria® 2023, and 27.2% (n = 12) were identified with at least one PIM using STOPP criteria. Using the updated Beers Criteria® 2023 and STOPP Criteria 2023, the study identified 50 PIMs (averaging 0.9 PIMs per participant) based on Beers Criteria® and 31 PIMs (averaging 0.6 PIMs per participant) based on STOPP Criteria, respectively. Bivariate logistic regression revealed a significant association between having nine or more comorbidities and PIMs according to Beers Criteria® (odds ratio (OR) = 8.4, 95% confidence interval (CIn) = 1.27–55.39, p = 0.027). This study highlights the high prevalence of PIMs among older adults with CI or dementia, emphasizing the need for regular medication reviews. Implementing both criteria can enhance medication management and improve patient safety in this vulnerable population.

Pharmacy doi: 10.3390/pharmacy13030081

Authors: Aleena Langlay Jeanine Abrons Andrea Daly

Objectives: To determine the willingness of Jamaican pharmacists to stock and dispense smoking cessation aids and determine barriers to selling products. Design: A descriptive study that utilized pharmacist-completed surveys. The participants received a sectionalized survey and a structured questionnaire tool. Data collection took place over six weeks. Setting: Pharmacists practicing in pharmacies registered by the Pharmacy Council of Jamaica (PCJ) Participants: A total of fifty-seven registered community pharmacists. Results: Most pharmacies (87.7%) do not stock smoking cessation aids. The most identifiable products were nicotine patches/nicotine gum. Pharmacists’ barriers to selling were cost (42%), lack of knowledge of the process of obtaining cessation aids (27.3%), and low demand from patients/clients (22.7%). Most pharmacists (86%) were willing to stock cessation aids. Of the total product requests, 61.2% were lodged by persons 26–50 years old. The stocking of products was not independent of location (p < 0.005). Conclusion: The barriers to the availability of smoking cessation aids, once adequately addressed, could positively enhance the achievement of smoking cessation practices.

Pharmacy doi: 10.3390/pharmacy13030080

Authors: Bradley Brown Megan Undeberg Angela Stewart Kimberly McKeirnan

Background: Rural communities in the United States experience significant barriers in accessing healthcare, including inadequate numbers of providers and local healthcare facilities. These barriers are exacerbated during seasons with high rates of respiratory diseases when rural clinics and providers may be overwhelmed. When mild, many of these respiratory diseases may be managed effectively in alternate settings, including community pharmacies. Investigators interviewed pharmacists in Washington State to explore the capacity of pharmacists and pharmacies to provide test-to-treat services for COVID-19, influenza, and strep throat. Methods: A qualitative study design was used to conduct key informant interviews with pharmacists who precepted student pharmacists from a local university. Twenty interviews were conducted, transcribed, and qualitatively evaluated to identify themes. The 5 A’s of Access were utilized as a theoretical framework. This framework describes five domains of access, including affordability, availability, accessibility, accommodation, and acceptability. Results: Qualitative analysis identified several themes that described the benefits of offering test-to-treat services in rural communities, such as reducing geographical barriers to accessing care, reducing wait times for patients, and reducing the number of patients seeking higher levels of care for basic treatments. Barriers to offering test-to-treat services identified by pharmacist participants included difficulties with receiving payment for services, challenges with adequate staffing, and the lack of awareness among many people in rural communities that pharmacies offer test-to-treat services. Conclusions: Rural communities experience challenges with the limited capacity of healthcare providers to meet the needs of patients in their communities. The results of this qualitative analysis may be useful to pharmacists in U.S. states where collaborative drug therapy agreements or collaborative practice agreements allow the provision of test-to-treat services. By providing test-to-treat services, pharmacists can increase access to care for rural patients and alleviate the burden of offering these services from other healthcare providers.

Pharmacy doi: 10.3390/pharmacy13030079

Authors: Bayan F. Ababneh Hisham Z. Aljamal Rabia Hussain

Background: Self-medication is the use of medicinal products to treat self-diagnosed disorders or symptoms without the prescription or supervision of a healthcare professional. There is a lack of data about self-medication knowledge, attitudes, and practices among pharmacy undergraduates in Malaysia. This study assessed the knowledge, attitudes, and practices among undergraduate pharmacy students in Penang regarding self-medication. Method: A descriptive cross-sectional study was conducted using a self-administered, web-based survey (Google Forms), which was completed and responded to by 203 undergraduate pharmacy students from Penang, Malaysia, between October and December 2023. Descriptive statistics were used to summarize the socio-demographic characteristics of the participants. Associations between the socio-demographic characteristics of the participants and the knowledge, attitudes, and practices regarding self-medication were assessed using a chi-square test. Regression analyses were carried out to determine whether the socio-demographic characteristics of the participants were associated with practices of self-medication. Results: A total of 203 of the undergraduate pharmacy students completed the questionnaire. More than half of the participants’ age ranged between 19 and 21 years old, the majority were females (77.3%), and 31.5% of the participants had family members employed in the healthcare sector. Most respondents showed good knowledge in a variety of domains: 97.5% acknowledged the potential for drug interaction with other medications, indicating a high awareness of proper self-medication practices. A positive attitude was found regarding participants’ attitudes toward self-medication, and 65.5% practiced self-medication, primarily for treating minor illnesses (75.9%). Common conditions included fever (83.3%), cough/cold/flu (76.8%), and headache (71.4%). Reasons for not self-medicating included the absence of illness (20.2%), lack of knowledge/prior experience (19.2%), and fear of using the wrong medication (18.7%). Only academic year level was the predictor of practicing self-medication within the last six months among the participants. Conclusions: Generally, the participants possessed good knowledge and positive attitudes toward self-medication. The study revealed no significant associations between demographic characteristics and knowledge or attitudes. Insights from this research contribute to understanding self-medication practices among pharmacy students in Penang, informing potential interventions to promote responsible self-medication practices.

Pharmacy doi: 10.3390/pharmacy13030078

Authors: Joyce Y. Lee Daniela Arcos Daniella Chan Celine Karabedian José Mayorga

Hands-on continuous glucose monitoring (CGM) training is yet to be integrated intentionally into most pharmacy curricula. The objective of this study was to examine pharmacy students’ perceptions of receiving hands-on CGM training as part of their core therapeutics in diabetes. Anonymous, voluntary pre-post surveys were administered to two cohorts of 3rd-year pharmacy students from a public pharmacy school in Southern California. Pharmacy students from other class levels were excluded. The surveys, consisting of Likert scale and open-ended questions related to different aspects of CGM, were administered via a web-based learning management system. Descriptive analyses were utilized to summarize the data. In total, 84 (98%) and 79 (92%) students completed the pre- and post-activity surveys, respectively, with an average of 12.5 days of CGM wear. After receiving the CGM training, 94% of the students recommended the integration of hands-on CGM training into the PharmD curriculum. In addition, the number of students who felt confident coaching patients on CGM use more than doubled from 30% to 85%, with 73% reporting added benefits of improved personal health behaviors. In conclusion, pharmacy students’ perceptions of integrating hands-on CGM education as part of their core curriculum were largely positive with added benefits of self-care.

Pharmacy doi: 10.3390/pharmacy13030077

Authors: Devin Scott Amy Hall Rachel Barenie Crystal Walker Muneeza Khan Paul Koltnow William R. Callahan Alina Cernasev

As the US population ages, the number of prescriptions managed by patients and healthcare teams is increasing. Thus, discontinuing or reducing medications that are considered to pose more risks than benefits can be achieved through deprescribing. Despite increasing calls for a stronger focus on deprescribing in healthcare education, current discussions highlight the lack of training on this topic within healthcare curricula. This is a significant barrier to effectively implementing the deprescribing process. This study aimed to characterize healthcare professional students (HPSs)’s perspectives on deprescribing within an interprofessional healthcare team, particularly regarding the motivations and roles of these future practitioners. Methods: Focus groups were conducted with HPSs at the University of Tennessee Health Science Center. The data collection, guided by a conceptual model, took place over three months in 2022. Data analysis was performed using thematic analysis, during which themes were identified through inductive coding. Results: Participants (n = 36) represented various faculties, including medicine, pharmacy, health professions, nursing, and dentistry. Two themes emerged: (1) Healthcare Team Members’ Roles and Responsibilities (2) “Put Me in, Coach”: Patient Safety Motivates Deprescribing. Conclusion: Data from HPSs highlighted the importance of an interprofessional healthcare team approach to deprescribing. Based on these insights, educators and practitioners should focus on establishing strong interprofessional healthcare teams that privilege open communication. Teams should consider deprescribing as a patient safety concern, as this may galvanize the team and provide additional motivation for performing the necessary work of deprescribing.

Pharmacy doi: 10.3390/pharmacy13030076

Authors: Ivo Heyerdahl-Viau Francisco Javier Prado-Galbarro Santiago ávila-Ríos Osmar Adrian Rosas-Becerril Raúl Adrián Cruz-Flores Carlos Sánchez-Piedra Juan Manuel Martínez-Nú?ez

This study aimed to evaluate the therapeutic adherence to antiretroviral therapy (ART) and the cost of care for people living with HIV (PLwHIV) in the Condesa Specialized Clinics (CSCs). A cross-sectional observational study was conducted using the Adherence Follow-Up Questionnaire developed by The AIDS Clinical Trials Group (ACTG) to measure adherence in 261 PLwHIV. An economic Markov model was developed to simulate clinical outcomes, health costs, and quality-adjusted life years (QALYs) over a 5-year horizon from the CSC perspective. The mean adherence index was 89.97, and 59% of the surveyed PLwHIV were non-adherent, but more than 95% of the population had an undetectable viral load, suggesting that ART remains effective in achieving clinical goals, even under suboptimal adherence conditions. More than half of the surveyed PLwHIV (60.54%) stated that they had stopped taking their ART at some point, and the three most frequent causes were forgetting (49.37%), being away from home (45.57%), and having a change in their daily routine (25.95%). The economic model showed a cumulative cost per PLwHIV of USD 8432 and 3.80 QALYs (USD 2218/QALYs), which is below the threshold of willingness to pay in Mexico (USD 13,790/QALY). These findings provide valuable information to guide public health decisions and resource allocation in HIV management in Mexico.

Pharmacy doi: 10.3390/pharmacy13030075

Authors: Audrey Flornoy-Guédon Liliane Gschwind Antoine Poncet Pierre Chopard Caroline Fonzo-Christe Pascal Bonnabry

Engaging patients in medication safety is essential but remains under-addressed in hospital settings. This pilot study aimed to assess the impact of an educational intervention—the Medication Safety Adventure Trail—on medication safety knowledge and satisfaction among hospital visitors. A quasi-experimental pre-post intervention using this educational tool was conducted over five days. A booth was set up in a hospital lobby inviting all passers-by to follow a six-step trail involving riddles to solve. The experiment comprised three phases: 1. Briefing plus pre-test; 2. The trail; 3. Debriefing plus post-test. A logistic mixed-effects model was employed to assess changes in the odds of correct responses to eight items between the pre-test and post-test. A five-point scale assessed participants’ degrees of certainty (DC) in their answers, and a comparison pre- and post-test was performed with a linear mixed-effects model. Satisfaction was based on Kirkpatrick’s levels 1 and 2 (reaction and learning) and was assessed using categorical scales and open-ended questions. A total of 93 participants completed the trail (60% non-healthcare professionals, 36% healthcare professionals, and 4% unspecified). The odds of a correct answer were higher at post-test than at pre-test (72% vs. 51%, p < 0.001), and the odds of providing a correct answer were nearly five times higher following the activity compared to before (OR = 4.8 [95%CI 3.5 to 6.4], p < 0.001). The mean DC was also improved from pre-test to post-test (4.43, 95%CI [4.36–4.49] vs. 4.83, 95%CI [4.80–4.86]; p < 0.001). All 93 participants reported being either very satisfied (89%) or satisfied (11%) with the educational tool. The tool significantly improved participants’ knowledge about medication safety issues and was appreciated.

Pharmacy doi: 10.3390/pharmacy13030074

Authors: Jessica Pace Andrew Bartlett Tiffany Iu Jessica La Jonathan Penm

(1) Background: Structured use of feedback and self-reflection in simulated counselling sessions has a number of benefits, including identification of strategies for improvement, improvement in key skills and adaptability and a patient-centred approach which will help them to succeed as effective healthcare practitioners. The aim of this study was therefore to explore students’ perceptions of self-reflection and feedback in patient counselling simulations and the development of patient counselling skills; (2) Methods: Focus groups explored student perceptions of how the combination of self-reflection, self-assessment and teacher and peer feedback impacted their performance in simulated patient counselling assessments; (3) Results: Four focus groups with 21 pharmacy students were conducted. We identified three main themes and associated subthemes: consistency and continuity (sub-themes learning through repetitive assessment and inconsistent expectations), perceptions of feedback (sub-themes tutor feedback, peer feedback and self-reflection) and real-life practice (sub-themes authenticity of simulation cases, perceptions of empathy and professional development); (4) Conclusions: This study highlights the critical role of integrating consistent, high-quality feedback, peer assessment, and self-reflection in pharmacy education to enhance students’ learning experiences and prepare them for professional practice. As workplace-based assessment becomes more common and expected by accreditation bodies, these insights underscore the need for structured and continuous feedback processes to be integrated into all areas of pharmacy curricula.

Pharmacy doi: 10.3390/pharmacy13030073

Authors: Dawid Piecuch Edyta Hańczyk Szymon Kopcia? Natalia Pawelec Weronika Mazur Karolina Kornatowska

Crohn’s disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract that leads to significant deterioration in patients’ quality of life. Biologic therapy, including the use of ustekinumab (UST), is a modern approach to treating the moderate to severe form of CD, especially in patients refractory to traditional treatments. UST, which acts as an interleukin IL-12 and IL-23 antagonist, has shown high efficacy in reducing inflammation, improving quality of life, and promoting mucosal regeneration and fistula healing. However, the use of biologic therapies, such as UST, has challenges related to the timing of treatment and patient response, including the problem of immunogenicity. To determine the clinical efficacy and safety profile of UST in the treatment of CD, a review of the literature published in the PubMed database over the last 5 years was conducted. After excluding articles that did not meet the inclusion criteria, we analyzed 42 clinical studies. The review discusses the available data on the efficacy and safety of UST, as well as its comparison with other biologic therapies, such as infliximab and adalimumab. UST, although not significantly greater to adalimumab, has lower immunogenicity and higher treatment retention. The therapeutic value of UST is also confirmed by biosimilars such as ABP 65 and FYB202, which show comparable efficacy and safety profile. The analysis of predictive biomarkers, such as serum drug levels and baseline eosinophil levels, could be an important element in the future personalization of CD treatment. The review’s findings point to the importance of further research to improve the tailoring of therapies to individual patients and improve long-term treatment outcomes.

Pharmacy doi: 10.3390/pharmacy13030072

Authors: Jennie B. Jarrett Abigail T. Elmes-Patel Sheila M. Allen Marlowe Djuric Kachlic Allison E. Schriever Tara P. Driscoll Ara Tekian Jeffrey J. H. Cheung Edward Podsiadlik Stuart T. Haines Alan Schwartz

The objective was to evaluate the growth in pharmacy student performance in entrustable professional activity (EPA) assessments across the experiential curriculum based on preceptor assessments on an entrustment–supervision (ES) scale. This retrospective cohort study used assessments based on the 2016 American Association of Colleges of Pharmacy Core EPAs and an expanded ES scale during introductory and advanced pharmacy practice experiences (IPPEs/APPEs) in the third and fourth professional years from fall 2020 to fall 2023. The primary outcome was the change in ES level, assessed by preceptors over time. The secondary outcomes were growth rates across types of experiences, training environments, and experience order. A conditional growth curve model and ordinal mixed effects model were used to demonstrate discrete entrustment decisions. A total of 509 students received 12,426 assessments by 557 preceptors. Raw ES levels and unconditional growth curves for EPA show increases in entrustability from years P3 to P4. Comparing care settings, there was lower entrustment in inpatient than outpatient settings and at academic medical centers than other settings. There were no significant differences in ES levels regardless of which IPPE was taken first. However, when the first APPE was an inpatient medicine experience, ES levels across APPEs for EPA 3 were higher when compared to ambulatory care as the first APPE, and they were higher for EPA 5 when compared to community pharmacy as the first APPE. Paired with ES scales, EPAs can be integrated into pharmacy experiential curricula to demonstrate longitudinal growth in student entrustment.

Pharmacy doi: 10.3390/pharmacy13030071

Authors: Selina Taylor Shelby Joyce Ruby Schembri Josh Swain Rachael Turiano Beverley D. Glass

Accessing essential healthcare services presents a challenge for consumers living in rural and remote communities, leading to higher rates of chronic disease and poorer health outcomes. Community pharmacists are well positioned to address this lack of access; thus, this study aimed to explore the perceptions of rural and remote consumers and pharmacists with respect to community pharmacists expanding their services in these communities. Qualitative, semi-structured interviews were undertaken with consumers and pharmacists recruited from community pharmacies in the far north, north west, and central west Queensland. The Consolidated Framework for Implementation Research guided question development, with the responses deductively coded and thematically analysed. Thirteen pharmacists and twenty-three consumers were interviewed, with both groups citing the benefit of reduced wait times. Key barriers were pharmacist workload, time constraints, inadequate infrastructure, and limited consumer awareness of services. Pharmacists highlighted the need for better reimbursement models and professional collaboration, while consumers valued accessibility and convenience but were concerned about the costs of services. This study has highlighted the benefits of expanded pharmacy services as perceived by the key stakeholders: consumers and pharmacists. However, future research investigating a larger sample in more rural and remote locations is needed to ensure the successful implementation of sustainable funding models to deliver better access and health outcomes for consumers in these communities.

Pharmacy doi: 10.3390/pharmacy13030070

Authors: Elise Moore Caroline Gaither Olihe Okoro Laura Palombi L’Aurelle A. Johnson

This study aims to examine the current wellbeing among pharmacy students in underrepresented groups (URGs) and investigate the impact on having access to affinity groups. A survey was distributed to students in April and May 2023, at a Midwestern College of Pharmacy, centering around diversity, equity, inclusion, and accessibility (DEIA) efforts and their impact on student wellbeing and experiences with the college-supported affinity groups. Student responses were analyzed using descriptive statistics. Sixty-five (75%) of the eighty-six students who completed the survey identified with at least one URG. First-generation students (n = 36), underrepresented racial/ethnic groups (n = 24), and LGBTQ+ (n = 13) were the three most prominent groups. Twenty-seven percent (n = 23) of students belonged to multiple URGs. Among the students in URGs, three out of four experienced distress. The students in URGs experienced distress at a higher rate compared to their peers in all categories. Twenty percent (n = 16) of students did not agree that there was equitable treatment on campus. This rate was higher among students in URGs compared to their peers. Eighty-three percent (n = 52) of individuals who did not participate in an affinity group recognized there was a need. Among individuals who did not participate, nearly half identified with a URG. Pharmacy students, especially those in URGs, may benefit from additional interventions by pharmacy schools to improve the offering and visibility of supportive services. Providing URG-centered resources addresses the gap between the wellbeing and academic experience of pharmacy students in URGs compared to their peers.

Pharmacy doi: 10.3390/pharmacy13030069

Authors: Jenifer Santos Manuel Machuca

This study evaluated an innovative teaching methodology in a Health Anthropology course for Pharmacy students aimed at transforming their perceptions of diabetes. Through patient interviews and the photovoice technique, students gained deeper insights into the psychosocial aspects of the disease. Surveys were administered at the beginning, midpoint, and end of the course to assess shifts in students’ perspectives. The results revealed a significant change, with students evolving from a primarily biomedical view to a more holistic understanding, emphasizing the patient’s lived experience. Additionally, students responded positively to the innovative approach, citing enhanced motivation and learning, though some noted the methodology’s demanding workload. This teaching intervention fostered empathy and a broader perspective on the challenges faced by patients living with diabetes, supporting a more patient-centered and humanistic approach to healthcare. Despite the positive feedback, there was some uncertainty about whether this methodology could be applied to other subjects within the Pharmacy curriculum.

Pharmacy doi: 10.3390/pharmacy13030068

Authors: José Luis Poveda Pablo Arnáiz Silvia López Belén Mu?oz Anxo Fernández-Ferreiro

The process of evaluation and selection of drugs in Spain is currently changing, with hospital pharmacists (HPs) having a growing relevance. This cross-sectional observational study aimed to assess HPs’ preferences for different hypothetical intravitreal treatments for neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME). Best corrected visual acuity (BCVA), ocular adverse events (AE), annual drug cost, available presentation, and mechanisms of action (MoA) were the selected attributes. A conjoint analysis was used. Ninety-one HPs completed the study. The mean (SD) age was 39.2 (10.2) years, 60.4% were female, and the mean (SD) time of experience as HP was 12.6 (8.3) years. For nAMD treatments, BCVA (38.6%) and ocular AE (27.3%) were the most important attributes, while annual drug cost (16.3%), available presentation (11.1%), and MoA (6.7%) were not as important. For DME drugs, BCVA (44.6%) and ocular AE (25.5%) were the most significant factors; annual drug cost (17.9%), the drug’s available presentation (7.3%), and MoA (4.8%) were not considered to be as crucial. Preferences were comparable independent of HP experience. Effectiveness and safety were the most important attributes when choosing a drug. Comprehending the significant characteristics for HPs could potentially improve their collaborative function within multidisciplinary teams involved in intravitreal treatments.

Pharmacy doi: 10.3390/pharmacy13030067

Authors: Ching Y. Low Kenneth L. McCall Brian J. Piper

Background: Tapentadol is an atypical opioid with a dual mechanism as a mu agonist and norepinephrine reuptake inhibitor. This study characterized tapentadol use in the United States (US) using three databases. Methods: Drug distribution data from 2010 to 2020 were extracted from the Drug Enforcement Administration (DEA)’s Automated Reports and Consolidated Orders System (ARCOS), including use per region (mg/person) and business activity (i.e., pharmacy). Tapentadol prescription claims from the Medicare and Medicaid programs for 2010–2020 were also examined. Results: The distributed amount of tapentadol was 3.5 tons in 2020. Distribution was over twice as high in southern (South Atlantic = 29.0 mg/person, East South Central = 28.8) relative to Pacific (12.9) or New England (12.8) states. Tapentadol use decreased nationally between 2012 and 2020 by −53.8%. Adult diabetes prevalence was significantly associated with tapentadol distribution in 2012 (r(50) = +0.44, p < 0.01) and 2020 (r(50) = +0.28, p < 0.05). Tapentadol prescribing to Medicaid patients declined −55.2% from the peak year, 2011, until 2020. Tapentadol prescribed by Nurse Practitioners accounted for over one-sixth (18.0%) of 2019 in Medicare. Conclusions: There has been a substantial decline over the past decade in tapentadol distribution and prescribing. However, the substantial regional differences may warrant further attention by opioid stewardship programs.

Pharmacy doi: 10.3390/pharmacy13030066

Authors: Christina L. Mnatzaganian Caitlin M. Gibson Lisa Kipper Charlene R. Williams Tram B. Cat

Pharmacy preceptors often feel unprepared to support and manage underperforming student pharmacists in experiential education settings. Further, there is little guidance on how preceptors can best support struggling student pharmacists with mental health concerns or those requiring disability accommodations. Further, recent literature has demonstrated elevated rates of preceptor burnout when working with difficult students. Resources to address challenging experiential student pharmacist situations were gathered through a literature review and from several offices of experiential education. This toolkit aims to provide strategies and resources to support preceptors working with struggling student pharmacists, particularly those facing mental health challenges and/or those requiring accommodations.

Pharmacy doi: 10.3390/pharmacy13030065

Authors: Domenica Francesca Mariniello Raffaella Pagliaro Vito D’Agnano Angela Schiattarella Fabio Perrotta Andrea Bianco

Background: Accelerating recovery and preventing the progression to more severe outcomes for patients with coronavirus disease 2019 (COVID-19) is of paramount importance. Non-steroidal anti-inflammatory agents (NSAIDs) have been widely adopted in the international recommendations for non-severe COVID-19 management. Among NSAIDs, evidence about the efficacy of ketoprofen lysin salt (KLS) in the treatment of non-severe COVID-19 has not been reported. Methods: This retrospective study compared the outcomes of 120 patients with mild to moderate COVID-19 treated at home with KLS between March 2021 and May 2023 compared with the outcomes of 165 patients who received corticosteroids. The outcomes included hospitalization, the need for oxygen supplementation, clinical recovery from acute COVID-19, and time to negative swabs. Results: Symptoms persisted in a lower percentage of patients in the KLS group compared to the corticosteroids group (p < 0.0001) and for a shorter period (p = 0.046). We found 6 patients (5%) in the KLS group were hospitalized compared to 45 (27%) in the corticosteroids group (p < 0.001). A higher percentage of patients in the corticosteroids group require oxygen administration (p < 0.001). In addition, patients taking corticosteroids showed a longer viral shedding period compared to those taking KLS (p = 0.004). A final multivariate analysis suggests that KLS might reduce hospitalization risk, the need for oxygen supplementation, and the persistence of post-COVID-19 symptoms when compared to an oral corticosteroid after adjusting for significant co-variables. Conclusions: KLS might have a positive effect on clinical recovery in non-severe COVID-19 patients. A comparison with other NSAIDs in terms of difference in efficacy and safety should be investigated in further trials.

Pharmacy doi: 10.3390/pharmacy13030064

Authors: Léa Solh Dost Giacomo Gastaldi Marie P. Schneider

This case report explores the experience of a newly diagnosed type 2 diabetes (T2DM) patient transitioning from passive non-adherence to active adherence over a two-month period following hospital discharge. During this two-month period, he participated in four exploratory, non-interventional research interviews investigating his medication adherence, beliefs, and self-management strategies. His feedback on these research interviews highlighted the role of key communication strategies—such as patient partnership, non-judgmental communication, and interprofessional active listening—in fostering self-reflection and behavioural change. While these techniques are well-documented, there remains an urgent need to translate them into routine practice by integrating behavioural science and interprofessional collaboration into healthcare pregraduate and postgraduate education in order to increase awareness and skills in clinical environments.

Pharmacy doi: 10.3390/pharmacy13030063

Authors: Flavia Nossa Massimiliano Franco Alberto Magni Emanuela Raimondo Giuseppe Ventriglia Fabrizio Gervasoni

Musculoskeletal disorders represent one of the most pervasive health concerns that drive frequent medical consultations and pharmacy encounters. Community pharmacies are well placed to help address this demand as they are accessible settings for healthcare advice and support for patients with musculoskeletal disorders complaining of pain. Heat therapy stands as a valuable component of a multimodal approach to the management of musculoskeletal pain by virtue of multiple effects: pain relief, reduction of muscle spasms and stiffness, and enhanced muscle flexibility and range of motion. However, there is limited guidance on heat therapy use in routine practice, particularly on indications and contraindications, mode of application, and precautions. Such an educational gap has been documented among pharmacists. Therefore, it is paramount that pharmacists gain knowledge about when and how to effectively integrate superficial heat therapy with both pharmacological and physical therapy, to provide patients with a comprehensive, multimodal approach to alleviating musculoskeletal pain. A multidisciplinary panel of experts gathered to develop practical guidance on heat therapy-appropriate application in patients with musculoskeletal pain. In this work, we provide actionable suggestions to build pharmacists’ competency in managing musculoskeletal pain and empower them in effectively using heat therapy as a single therapeutic option or in combination with over-the-counter analgesics.

Pharmacy doi: 10.3390/pharmacy13030062

Authors: Do Xuan Thang Nguyen Viet Hung Vu Tran Anh Vu Thi Quynh Mai Le Thu Thuy Cuc Thi Thu Nguyen Trung Nguyen Duc Dang Viet Hung

The study aimed to investigate the determinants of pharmacy postgraduates’ satisfaction to suggest essential recommendations to enhance educational quality at Hanoi University of Pharmacy in Vietnam. A cross-sectional survey was conducted among 202 postgraduates using structured questionnaires, with 31 multidimensional questions and 1 question addressing overall satisfaction. Cronbach’s alpha was used to evaluate the questionnaire’s internal consistency, Exploratory Factor Analysis (EFA) identified key factors, and multiple linear regression analysis was applied to assess the impact of these factors. Overall satisfaction had a high mean score of 4.49 out of 5 (SD = 0.602). The final 29 questions were retained and divided into four main factors affecting satisfaction after rotating EFA. The dimension of “Support and Evaluation” was the most influential factor (β = 0.475), followed by “Training Organization”, “Facilities and Library”, and “Lecturers and Curriculum”. The variables with the lowest scores needed much more attention, including digital systems (4.2, SD = 0.852), information technology support (4.32, SD = 0.772), activities boosting lifelong learning skills (4.48, SD = 0.624), and the reasonability of the education program’s structure (4.48, SD = 0.608) and the studying program’s schedule (4.45, SD = 0.607). The findings indicate the issues that should be addressed, and have highlighted that improvements in electronic library accessibility and updated curricula are also recommended to further optimize the educational experience of postgraduate students.

Pharmacy doi: 10.3390/pharmacy13030061

Authors: Kaveh Naseri Thilini Thrimawithana Ayman Allahham Vivek Nooney Barbora de Courten Wejdan Shahin

Complementary medicines (CMs) are widely used worldwide, with usage rates ranging from 24% to 71.3%. Despite their popularity, many CMs lack robust scientific support and can potentially lead to adverse health effects. Limited research exists on CMs-related adverse events and the role of CMs’ labels in conveying crucial information to consumers. This cross-sectional study investigated the usage, consumer perspectives, and influence of labels specifically on product-based CMs, including nutritional supplements, vitamins, minerals, probiotics, prebiotics, and herbal medicines. Practitioner-led therapies and mind-body practices were outside the scope of this research. Data were collected through an online questionnaire and analyzed using descriptive statistics and correlation analysis. The study enrolled 125 participants who were current CMs users. Pharmacies and supermarkets were the primary sources for CMs procurement. Participants’ perceptions of CMs effectiveness and safety were positively correlated. Label warnings prompted participants to seek additional information, but consultation with healthcare professionals was infrequent. Adverse reactions were reported by 18.5% of participants, with self-management approaches being common. Label warnings play a significant role in prompting consumers to seek more information about CMs. However, the limited engagement of healthcare professionals, especially pharmacists, suggests an opportunity for improved consumer education and pharmacist involvement in CMs-related discussions. Addressing these aspects can lead to safer CMs practices and informed decision-making among consumers.

Pharmacy doi: 10.3390/pharmacy13030060

Authors: Alexander Kilian Ullmann Oliver Bach Kathrin Mosch Thilo Bertsche

Background: In intermediate care, older patients with polypharmacy are vulnerable to drug–drug interactions (DDI) and potentially inappropriate medication (PIM). Aims: To perform a consecutive intervention study to evaluate DDI/PIM. Methods: Clinically-relevant DDI/PIM were identified using AMeLI (electronic medication list) and PRISCUS 2.0 (PIM list). Consecutive patients (standard care group) were screened for DDI/PIM after admission (t0) and again before discharge (t1). In an interim period, physicians received general education about DDI/PIM. Then, consecutive patients (independent clinical pharmacy group) were screened for DDI/PIM after admission (t2). Physicians were then provided with patient-individualized recommendations by a clinical pharmacist to prevent DDI/PIM. The patients were then screened again for DDI/PIM before discharge (t3). Results: In each group, 100 patients were included with data available for evaluation from 97 (standard care group, median age: 78 years [Q25/Q75: 69/84]) and 89 (clinical pharmacy group, 76 years [67/84]). In the standard care group, DDI were identified in 55 (57%) patients after admission (t0) and 54 (56%) before discharge (t1, ARR[t0/t1] = 0.01, NNT[t0/t1] = 100, n.s.). In the clinical pharmacy group, DDI were identified in 32 (36%) after admission (t2; ARR[t0/t2] = 0.21/NNT[t0/t2] = 5, p < 0.01) and 26 (29%) before discharge (t3; ARR[t2/t3] = 0.07/NNT[t2/t3] = 15, n.s.; ARR[t1/t3] = 0.27/NNT[t1/t3] = 4, p < 0.001). PIM were identified in patients at t0: 34 (35%), t1: 35 (36%, ARR[t0/t1] = −0.01/NNH[t0/t1] = 100, n.s.), t2: 25 (26%, ARR[t0/t2] = 0.09/NNT[t0/t2] = 12, n.s.), t3: 23 (24%, ARR[t2/t3] = 0.11/NNT[t2/t3] = 10, n.s.; ARR[t1/t3] = 0.12/NNT[t1/t3] = 9, n.s.). Conclusions: In the standard care group, after admission, many DDI/PIM were identified in older intermediate care patients. Before discharge, their number was hardly influenced at all. General education for physicians led to DDI prevention after admission. In addition, the DDI frequency decreased by providing physicians with patient-individualized recommendations.

Pharmacy doi: 10.3390/pharmacy13030059

Authors: Vanya Rangelov Kozhuharov Radiana Staynova Kalin Ivanov Hristo Manev Stanislava Ivanova

Humanity has used and explored various performance-enhancing remedies since ancient times. To protect clean sport, athletes’ health, and to provide fair and transparent competitions, different anti-doping policies were implemented. Nowadays, the anti-doping policies are evolving every year and are governed by the World Anti-Doping Agency. The use of doping in sports is regarded as a persistent problem across various athletic disciplines; at the same time, the topic of whether doping is preventable is highly discussed. The aim of this study was to assess the knowledge of medical specialists about doping compounds and to analyze their willingness and preparedness to participate in doping prevention programs. A cross-sectional questionnaire-based study was conducted between March 2024 and May 2024. Study participants included medical and pharmacy students, pharmacists, and medical doctors. Statistical analysis was performed using IBM SPSS Statistics version 24.0. Descriptive statistics, one-way analysis of variance (ANOVA), and independent-samples t-test were applied to analyze different variables. The results from the study suggested that healthcare professionals, particularly pharmacists, could be successfully engaged in doping prevention. Additionally, community pharmacies could also be involved in doping-prevention strategies since they are recognized as easily accessible healthcare locations. The relationship between medical specialists and professional athletes is essential for raising awareness, receiving trustworthy information, and developing decision-making capability to prevent not only the intentional but also the unintentional anti-doping rule violations.

Pharmacy doi: 10.3390/pharmacy13030058

Authors: Candis M. Morello Mark Bounthavong Jan D. Hirsch

To combine didactic education with clinical and research experiences that would empower student pharmacists to consider postgraduate training and a career in pharmacy education or academics, in 2009, the Next Generation of Pharmacist Educators (NextGenRxEd) program, a four-year longitudinal education program, was implemented at the University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences. Directed by two pharmacist faculty, a clinician and researcher, student pharmacists were exposed to hands-on experience with clinical management, patient care, and research processes. A post-graduation survey was created and administered in Fall 2024 to evaluate outcomes for all student pharmacists who completed the program. Key performance indicators included the number of pharmacy students proceeding to postgraduate training, research practices, and pharmacist positions involving education and academics. During 2009–2024, 34 student pharmacists completed the NextGenRxEd program; 71% achieved postgraduate education (22 PGY1 residencies and two fellowships). Following quality improvement implementation, this percentage increased from 50% to 89%, for Classes 2009–2015 and 2016–2024, respectively. Overall, the PGY1 match rate was 92%, and 19 abstracts/posters and 10 manuscripts were published, respectively. The post-graduation survey response rate was 85%, with 93% of respondents reporting that they precepted PharmD students; 14% became faculty members, and 66% participated in research. The NextGenRxEd program provides a model whereby student pharmacists are equipped to obtain post-graduate education and pursue a career with a significant role in pharmacy education or academic pharmacy. This program has the potential to be implemented at other pharmacy schools/colleges to benefit faculty and student participants.

Pharmacy doi: 10.3390/pharmacy13020057

Authors: Sne?ana Mugo?a Arijana Me?trovi? Veselinka Vuki?evi? Milanka ?ugi? Michael J. Rouse

Pharmaceutical care as a concept was introduced in Montenegro during the last 10 years. The Pharmaceutical Chamber of Montenegro (PCM) and the Institute for Medicines and Medical Devices (CInMED) conducted SMART Pharmacist Program educational activities for pharmacists as a project to improve their impact on monitoring drug safety. In the period from September 2023 to May 2024, a total of 78 pharmacists participated in the project, of which 53 (68%) submitted valid reports of suspected adverse drug reactions (ADRs). During the project, a total of 302 valid reports were submitted, and the pharmacists’ share in total reporting increased to 74% in 2023 compared to less than 10% in the previous 5 years. The results of this research will be used to make recommendations for further improvement of the pharmacovigilance system, as well as to create plans for continuing education (CE) of other health workers in the area of rational and safe use of medicines.

Pharmacy doi: 10.3390/pharmacy13020056

Authors: Tasneem Rizvi Syed Tabish R. Zaidi Mackenzie Williams Angus Thompson Gregory M. Peterson

Very few studies, all employing surveys, have investigated the perceptions of community pharmacists regarding antimicrobial stewardship (AMS). A qualitative inquiry exploring factors affecting community pharmacists’ participation in AMS may assist in the implementation of AMS in the primary care setting. This study aimed to explore the perceived barriers and enablers of community pharmacists’ participation in AMS. One-on-one semi-structured telephone interviews were conducted with a sample of community pharmacists from across Australia. Interviews were transcribed verbatim and analysed using the Framework Analysis method. Twenty community pharmacists (70% female), representing urban, regional, and remote areas of Australia participated in the study. Pharmacists identified a discord between clinical needs of patients and practice policies as the primary source of excessive prescribing and dispensing of antibiotics. The fragmented nature of the primary healthcare system in Australia was seen as limiting information exchange between community pharmacists and general practitioners about antibiotic use, that was encouraging inappropriate and, at times, unsupervised use of antibiotics. The existing community pharmacy funding model in Australia, where individual pharmacists do not benefit from any financial incentives associated with clinical interventions, was also discouraging their participation in AMS. Pharmacists suggested restricting default antibiotic repeat supplies, reducing legal validity of antibiotic prescriptions to less than the current 12 months, and adopting a treatment duration-based approach to antibiotic prescribing instead of the ‘quantity-based’ approach, where the quantity prescribed is linked to the available pack size of the antibiotic. Structural changes in the way antibiotics are prescribed, dispensed, and funded in the Australian primary care setting are urgently needed to discourage their misuse by the public. Modifications to the current funding model for pharmacist-led cognitive services are needed to motivate pharmacists to participate in AMS initiatives.

Pharmacy doi: 10.3390/pharmacy13020055

Authors: Divita Singh Omnia A. E. A. Mesalhy Michael J. Cawley

Background: Adverse drug reactions have been reported as leading causes of morbidity and mortality. Unfractionated heparin- and low-molecular-weight heparin-induced hyperkalemia are side effects that have been reported in approximately 7 to 8% of heparin-treated patients. Algorithms, assessment tools, and decision aids are needed to assist in determining the causality of these adverse drug reactions. Aim: The aim of this study was to determine the number of case reports of hyperkalemia resulting from unfractionated heparin or low-molecular-weight heparin use by utilizing the Naranjo Adverse Drug Reaction Probability Scale. Methods: PubMed, International Pharmaceutical Abstracts, and the Cochrane Library were searched for relevant publications. Search terms and Boolean operators, including “hyperkalemia AND heparin”, “hyperkalemia AND low molecular weight heparin”, “heparin AND hypoaldosteronism”, and “low molecular weight heparin AND hypoaldosteronism”, were used. Searches were limited to case reports and human specimens. Results: A total of 29 case reports were identified, incorporating 38 patient cases. Of the 38 patient cases, 5 [4 involving unfractionated heparin and 1 involving low-molecular-weight heparin] (13.2%) utilized the Naranjo Adverse Drug Reaction Probability Scale to identify the possibility of an adverse drug reaction occurring due to exposure to unfractionated or low-molecular-weight heparin as probable. Conclusions: The available evidence suggests that clinicians’ use of the Naranjo Adverse Drug Reaction Probability Scale to determine the potential of hyperkalemia occurring due to exposure to unfractionated heparin and low-molecular-weight heparin is limited. Clinicians should be encouraged to utilize an objective monitoring tool to help standardize assessment of causality for all adverse drug reactions.

Pharmacy doi: 10.3390/pharmacy13020054

Authors: Bradley Phillips Jason Powell

Objective: This study intends to evaluate simulated experiences provided to pharmacy students that directly compare the perspective of patients managing chronic disease states through traditional means without compliance aids to those using compliance aids, such as continuous glucose monitors (CGMs) and other devices. Methods: This simulation was conducted with third-year pharmacy students enrolled in the ambulatory care elective course at the University of Florida College of Pharmacy. It was designed to simulate a patient responsible for self-administering an array of medications for multiple chronic diseases that the students are likely to encounter during clinical practice. For the first week, students were tasked with adhering to a complex medication schedule from their associated pill bottles without the use of compliance aids (pill organizers, alarms, etc.) and checking their blood glucose twice daily using a traditional glucometer. In the second week, students continued the role of the patient; however, they were provided with compliance aids and encouraged to set alarms and use CGMs. Using a questionnaire developed based on the traditional Likert scale model, the students were able to quantify their experiences in a way that allowed the investigators to observe any changes. Results: Regarding the overall implications of this experience, most participants (>80%) agreed that this project increased their understanding of the value of compliance aids and devices and encouraged them to not only incorporate them into their future patient care plans but also advocate for accessibility to improve health outcomes. Conclusion: Students who completed this experience reported better adherence to chronic disease state control using compliance aids and, in turn, the applicability of the use of compliance aids in managing those with complex medication regimens. This simulation may encourage future pharmacists to incorporate compliance aids with their patients to improve health outcomes.

Pharmacy doi: 10.3390/pharmacy13020053

Authors: Vasco M. Pontinha Julie A. Patterson Dave L. Dixon Norman V. Carroll D’Arcy Mays Karen B. Farris David A. Holdford

Medication adherence is a crucial factor for managing chronic conditions, especially in aging adults. Previous studies have identified predictors of medication adherence. However, current methods fail to capture the time-varying nature of how risk factors can influence adherence behavior. This objective of this study was to implement multitrajectory group-based models to compare a time-varying to a time-fixed approach to identifying non-adherence risk factors. The study population comprised 11,068 Medicare beneficiaries aged 65 and older taking select medications for hypertension, high blood cholesterol, and oral diabetes medications, between 2008 and 2016. Time-fixed predictors (e.g., sex, education) were examined using generalized multinomial logistic regression, while time-varying predictors were explored through multitrajectory group-based modeling. Several predisposing, enabling, and need characteristics were identified as risk factors for following at least one non-adherence trajectory. Time-varying predictors displayed an alternative representation of those risk factors, especially depression symptoms. This study highlights the dynamic nature of medication adherence predictors and the utility of multitrajectory modeling. Findings suggest that targeted interventions can be developed by addressing the key time-varying factors affecting adherence.

Pharmacy doi: 10.3390/pharmacy13020052

Authors: Dhakrit Rungkitwattanakul Ebony Evans Ewanna Brown Kent Patterson Jr. Weerachai Chaijamorn Taniya Charoensareerat Sanaa Belrhiti Uzoamaka Nwaogwugwu Constance Mere

Background: In 2021, the National Kidney Foundation–American Society of Nephrology (NKF-ASN) recommended the use of the 2021 refit equation without race; however, the effect of the removal is unclear. Our research aimed to examine the implications of antidiabetic dosing and eligibility on the new 2021 equation among Black patients. Methods: This is a retrospective analysis of patients receiving care at the diabetes treatment center (DTC) of an academic medical center. Estimated glomerular filtration rates (eGFRs) based on serum creatinine were calculated using the 2009 and 2021 CKD-EPI equations. A Monte Carlo simulation was performed to create 10,000 virtual patients. Dosing simulations based on each estimate of kidney function were performed for antidiabetics based on product labeling. The proportion and percentage of patients who were eligible based on the estimates were calculated. Results: The percentages of patients ineligible for metformin based on the estimates from the 2009 and 2021 CKD-EPI equations at the DTC were comparable (8.02% and 8.36%, respectively). In our 10,000 simulated virtual patients, the percentage of ineligibility increased only by 1%. For the GFR cut points of 20 mL/min and 25 mL/min, the rates of ineligibility were similar in our cohort and simulated patients. Conclusions: The exclusion of race from the 2021 CKD-EPI equation may slightly reduce medication eligibility among Black patients.

Pharmacy doi: 10.3390/pharmacy13020051

Authors: Samuel Dyer Cherie Hyder Jeff Kraemer

Background: Medical Science Liaisons (MSLs) serve a vital role in facilitating the exchange of scientific knowledge between pharmaceutical companies and health care professionals (HCPs), including pharmacists, ensuring the dissemination of accurate, evidence-based information to support clinical decision-making. Evaluating MSL performance is critical for demonstrating their value, yet defining appropriate key performance indicators (KPIs) remains challenging due to the combination of scientific engagement, relationship-building, and other activities that are difficult to measure. Objective: This study examines the current and perceived ideal use of quantitative and qualitative metrics for MSL performance evaluation, the difficulties in measuring MSL impact, and the perceived effectiveness of existing KPIs. Methods: A global survey of 1023 medical affairs professionals across 63 countries was conducted, gathering data on which KPIs are currently used versus which should be used, the preferred weighting of qualitative vs. quantitative metrics, and opinions on measurement difficulty and KPI effectiveness. Results: The results reveal a strong preference for qualitative metrics (52%) over quantitative metrics (7%), though most organizations primarily use activity-based metrics such as the number of key opinion leader (KOL) engagements (92%). Despite these practices, many respondents believe that MSL KPIs should focus more on impact-based qualitative metrics, such as the quality of KOL/HCP relationships and/or engagements (70%) and the quality of actionable insights gathered (67%). Furthermore, 67% of participants reported it is “difficult” or “very difficult” to measure MSL performance accurately, and only 3% revealed current KPIs and metrics used to measure MSL performance are “very effective”. These findings highlight a disconnect between the way MSLs are evaluated and the value they provide. Conclusions: This study demonstrates the need for a balanced KPI framework that integrates both qualitative and quantitative measures. A more refined performance evaluation system (incorporating stakeholder feedback, insight quality, and strategic impact) can ensure fair assessments and drive MSL effectiveness.

Pharmacy doi: 10.3390/pharmacy13020050

Authors: Anwar A. Alghamdi

Drug safety is crucial in healthcare, ensuring the secure and effective administration of medications to protect patient welfare. Drug and medication safety is a major concern among Saudi healthcare providers, with numerous studies outlining the incidence of medication errors and the need for enhanced safety standards. This review will examine the existing level of drug-related safety in Saudi Arabia, categorizing the areas for improvement and highlighting concepts to improve safety practices. The overview discusses the history and evolution of pharmaceutical safety procedures, the present regulatory framework, major stakeholders, and the types and origins of prescription errors. It also examines the role of healthcare personnel and the use of technology and patient education in promoting pharmaceutical safety. The data reveal that the rate of pharmaceutical errors in Saudi hospitals is shockingly high, ranging from 13 to 56 per 100 medication orders, highlighting the urgent need for effective medication safety standards. Despite the formation of the Saudi Food and Drug Authority (SFDA) and the National Pharmacovigilance and Drug Safety Centre, issues such as poor understanding among healthcare providers and the need for more effective reporting methods remain a challenge. The evaluation highlights the deficiencies in ongoing education, such as real-world case scenarios and related trainings, inadequate incorporation of skills in assessment methods, and deficiency in standardized protocols for error reporting. To address these gaps, it is proposed to implement structured competency-based training, simulation exercises must be preferred for periodic skill assessments, and a safe reporting culture should be encouraged for the sake of transparency and learning from errors. We recognize the use of technology, such as electronic health records and computerized physician order input systems, as an important technique for improving medication safety. Future directions include creating national guidelines, establishing a centralized pharmaceutical error reporting system, and fostering a safety culture inside healthcare organizations. By addressing these obstacles and capitalizing on the opportunities indicated, we may improve pharmaceutical safety and, ultimately, patient care and outcomes in Saudi Arabia.

Pharmacy doi: 10.3390/pharmacy13020049

Authors: Ioana Popovici Manuel J. Carvajal

The literature shows that women persistently earn less than men for similar roles and qualifications; yet, pharmacy has been portrayed as an egalitarian profession, with a small gender earnings gap relative to other occupations. There is a lack of recent studies, and some evidence suggests a significant gender gap when earnings are estimated separately for male and female pharmacists. This study compared the nature and magnitude of gender income disparities using two alternative methodological procedures and evaluated the evidence for policy implications. The study was based on 2019–2022 American Community Survey (ACS) data collected by the U.S. Census Bureau. The sample consisted of 12,450 pharmacists (61.5% women) ages 25–64 years practicing in the U.S. Ordinary least-squares models calculated pharmacist annual incomes as functions of work input, human-capital, and job-related covariates. Results estimated a gender earnings gap of up to 18.6%. Differences across sociodemographic groups suggested that pharmacy is only friendly to selected segments of the profession. The empirical evidence reported here is expected to be used by healthcare managers and policymakers to inform ongoing discussion regarding the need for policy changes and cultural shifts to promote gender equity.

Pharmacy doi: 10.3390/pharmacy13020048

Authors: Nikhil Verma Shanmugapriya Vinayagam Niti Mittal Rakesh Mittal Neeraj Bansal

Background: The evaluation of internationally comparable indicators of medicine use is important to devise strategies to promote the rational use of medicines (RUM). Methods: A cross-sectional study was conducted in a tertiary care hospital from January to June 2024. Prescriptions were collected from the outpatient pharmacy using systematic random sampling and analyzed for WHO/INRUD core prescribing indicators, index of rational drug prescribing (IRDP) and completeness (general, treatment and prescribers’ details). Results: Out of 844 prescriptions collected, 607 were analyzed. A total of 1837 drugs were prescribed, with a mean (SD) of 3.03 (1.51) drugs per prescription; 1378 (75%) drugs were prescribed as generic names; 125 prescriptions (20.59%) had an antibiotic prescribed; and injectables were given in 7 (1.15%) prescriptions. Of the total 1837 drugs, 1018 (55.4%) were mentioned in the National List of Essential Medicines (NLEM) 2022, while 934 (50.8%) were included in the Haryana state essential medicines list (2013–2014). The IRDP was calculated as 3.86. The mean (SD) completeness score of the prescriptions was 10.33 (0.8) (range 5 to 11). Conclusions: There was a high incidence of polypharmacy, brand name and non-essential drug prescribing, while antibiotic and injection use were in accordance with WHO standards.

Pharmacy doi: 10.3390/pharmacy13020047

Authors: Takuma Matsumoto Takuya Mura Tsubasa Wada Yuki Tsugo Naoko Mukai Terutaka Hamaoka Shuji Horita Yasushi Semba Shinichi Watanabe

Naldemedine, a peripherally acting μ-opioid receptor antagonist, is used to treat opioid-induced constipation (OIC). However, it causes diarrhea as an adverse effect. This retrospective study aimed to investigate whether the occurrence of diarrhea was dependent on the timing of naldemedine treatment initiation. Inpatients who were initially treated with naldemedine at the Department of Respiratory Medicine, NHO Iwakuni Medical Center, Japan, between 1 December 2017 and 31 March 2021 were included in this study and divided into the simultaneous combination group, in which naldemedine was introduced at the same time as strong opioid analgesics, and the non-simultaneous combination group, in which naldemedine was introduced after the initiation of treatment with strong opioid analgesics. This study included 45 patients, 15 (33.3%) of whom developed diarrhea. Among the patients in the simultaneous combination group and non-simultaneous combination group, diarrhea occurred in 2 (11.1%) and 13 (48.1%) patients, respectively. Multivariate logistic regression analysis revealed that the delayed introduction of naldemedine was significantly associated with the development of diarrhea (odds ratio: 6.68, 95% confidence interval: 1.220–36.700, p = 0.028). Our analysis reveals that the simultaneous administration of naldemedine and oxycodone may prevent the development of diarrhea associated with naldemedine use for OIC.

Pharmacy doi: 10.3390/pharmacy13020046

Authors: Josiah Moore Ndidi Iheme Nicholas S. Rebold Harriet Kusi Constance Mere Uzoamaka Nwaogwugwu Earl Ettienne Weerachai Chaijamorn Dhakrit Rungkitwattanakul

Introduction: Health disparities affecting minority populations and resulting in poorer outcomes for disadvantaged groups have been documented in the literature. Sodium/glucose-cotransporter 2 (SGLT2i) inhibitors and GLP-1 receptor agonists (GLP-1RA) markedly decrease mortality from kidney and cardiovascular events. However, little is known about the factors and disparities that lead to differences in SGLT2i and GLP-1RA initiation across different ethnic groups. Methods: This scoping review queried databases using key terms related to disparities in the initiation of SGLT2i and GLP-1RA among high-risk populations. Relevant data from eligible studies were extracted, organized, and analyzed thematically to identify key trends and patterns in the literature. Result: Nineteen studies were included in this review. Key risk factors influencing uptake included age, provider type, race, sex, education, comorbidities, insurance, and income, with minority patients consistently showing lower rates of initiation due to systemic barriers and socioeconomic disparities. Patients who were younger, male, had higher education or income levels, and received care from specialists were more likely to use these therapies. Conclusion: The adoption of SGLT2i and GLP-1RA remains suboptimal despite their proven kidney and cardiovascular benefits. Targeted efforts to reduce socioeconomic and racial inequities based on the factors identified should be encouraged.

Pharmacy doi: 10.3390/pharmacy13020045

Authors: Etsuko Arita Yuko Masamura Rieko Takehira

Background: In pharmacy education in Japan, efforts continue to develop a model for ethics education that fosters high ethical standards and the problem-solving skills essential for medical professionals. This study qualitatively analyzed the attitudes of ethics educators—those who teach ethics classes—to establish a model of ethics education for pharmacy colleges in Japan. Methods: This study analyzed open-ended responses from 32 universities to the question, “What do you think about ethics education provided by faculties of pharmaceutical sciences?” Result: The qualitative analysis revealed that ethics educators at pharmacy colleges in Japan believe in the potential of ethics education to nurture problem-solving skills and logical thinking. However, the educator’s question whether or not the students would be able to apply ethics content in clinical settings as medical professionals. Another issue is that faculties of pharmaceutical sciences lack the staff and expertise to teach ethics. In other words, the educators lack the wherewithal to break the logjam in ethics education through their efforts; hence, they are desperate for an ethics education model. Conclusions: Based on our findings, further research is needed to design strategies that can enhance the quality of pharmacy education in Japan.

Pharmacy doi: 10.3390/pharmacy13020044

Authors: Derar H. Abdel-Qader Alia Saleh Abdullah Albassam Esra’ Taybeh Nadia Al Mazrouei Khalid Awad Al-Kubaisi Rana Ibrahim Reham Aljalamdeh Salim Hamadi Sahar Jaradat Shorouq Al-Omoush

Background: Although psychotropic medications (PMs) have enormous adverse events and may cause serious harm if administered inappropriately, there is a scarcity of research concerning the patterns and appropriateness of prescribing these medications in primary care in Jordan. This study aimed to investigate the patterns and appropriateness of PM prescription in primary care, as well as the types and frequency of pharmacist interventions in community pharmacies. Methods: A prospective observational study was conducted in 16 community pharmacies across Jordan. A data reporting sheet was developed, validated, piloted to ensure its applicability, and filled out over 12 weeks (April to June 2023), covering three regions in Jordan. Results: Overall, 426 patients with 469 prescriptions containing 919 PM orders were observed. Among the PMs prescribed, 19.4% were prescribed inappropriately. Among the PMs, 78.7% were dispensed by pharmacists. The inappropriate prescription categories (n = 178) were overprescribing (45, 25.3%), underprescribing (19, 10.7%), inappropriate medication choice (39, 21.9%), inappropriate duration of medication therapy (64, 36.0%), and inappropriate medication dosage (11, 6.2%). The top therapeutic category requested was anti-epileptics (23.9%). Conclusions: This study evaluated the prescribing patterns and appropriateness of PMs in Jordan, revealing notable instances of inappropriate PM prescriptions alongside varied and extensive pharmacist interventions.

Pharmacy doi: 10.3390/pharmacy13020043

Authors: Florina Madalina Mindru Adrian Gheorghe Bumbu Darian Faur

Ekbom Syndrome, also known as Delusional Parasitosis (DP), is considered a rare psychiatric condition. Based on diagnostic criteria, it is characterized by the strong belief of being infested with various parasites, as well as the presence of perceptual disturbances, usually tactile and/or visual hallucinations. The syndrome can manifest idiopathically or in connection with other medical conditions and substance use. Diagnosis is challenging, as patients tend to pursue dermatological care initially. This case report describes an 81-year-old female diagnosed with Ekbom Syndrome, presenting with severe anxiety, insomnia, and persistent delusions of infestation. Initial treatment with low-dose Risperidone (2 mg/day) was ineffective, requiring a dose escalation to 4 mg/day. However, the patient’s nonadherence to follow-up limited the assessment of long-term outcomes. This case highlights key clinical challenges in elderly patients, particularly dose titration, treatment response, and adherence issues. Comparative analysis with prior case reports suggests that higher doses of Risperidone (3–6 mg/day) may be required for symptom remission, but long-term outcomes remain uncertain. Additionally, nonadherence remains a major barrier, underscoring the need for structured monitoring and caregiver involvement. These findings offer insights into antipsychotic strategies for Ekbom Syndrome, highlighting individualized pharmacotherapy, long-term follow-up, and adherence support in elderly patients.

Pharmacy doi: 10.3390/pharmacy13020042

Authors: Candis M. Morello Eduardo S. Fricovsky

With diabetes reaching epidemic proportions globally, it is imperative to increase the number of providers equipped to screen, educate, and help patients achieve glycemic control. This study evaluated the long-term results of student pharmacists attending a first-year Diabetes Self-Care Education Program (DSEP) by measuring knowledge retention, confidence, and clinical applicability of skills learned over time. The DSEP, integrated into the early pharmacy curriculum, is a 9-h training program made up of interactive lectures, glucose monitoring assignments, and active-learning workshops. Following DSEP training, two cohorts of first-year student pharmacists were surveyed annually for 3 and 5 years to assess knowledge retention, confidence, and clinical use of the DSEP content in their practice sites. By the year 1 follow-up survey, the response rate from the pre-survey period for cohort 1 was 88% and 78% for cohort 2; over time, the response rate decreased. For the long-term follow-up surveys, cohort 1 (5 years) and cohort 2 (3 years) demonstrated overall significantly improved sustained knowledge of diabetes (48% higher average test score, p < 0.001), perceived confidence, and clinical ability (over 60% and 76% increases from baseline, p < 0.001). Within 12 months of completing the DSEP, about two-thirds of students applied their training to assist patients with diabetes and their caregivers. Long-term, participants in both cohorts reported educating and screening over 22,000 patients with diabetes and caregivers in multiple clinical settings over 3 years and 5 years, respectively, following DSEP training. The positive impact of improved knowledge, confidence, and clinical applicability of the DSEP training obtained by student pharmacists was sustained for 3 or more years, impacting thousands of patients with diabetes and caregivers. Considering the growing global diabetes epidemic, pharmacy schools around the world should consider implementing an early DSEP program.

Pharmacy doi: 10.3390/pharmacy13020041

Authors: Maree Donna Simpson Haider Saddam Qasim

Over the past five years, the application of artificial intelligence (AI) including its significant subset, machine learning (ML), has significantly advanced pharmaceutical procedures in community pharmacies, hospital pharmacies, and pharmaceutical industry settings. Numerous notable healthcare institutions, such as Johns Hopkins University, Cleveland Clinic, and Mayo Clinic, have demonstrated measurable advancements in the use of artificial intelligence in healthcare delivery. Community pharmacies have seen a 40% increase in drug adherence and a 55% reduction in missed prescription refills since implementing artificial intelligence (AI) technologies. According to reports, hospital implementations have reduced prescription distribution errors by up to 75% and enhanced the detection of adverse medication reactions by up to 65%. Numerous businesses, such as Atomwise and Insilico Medicine, assert that they have made noteworthy progress in the creation of AI-based medical therapies. Emerging technologies like federated learning and quantum computing have the potential to boost the prediction of protein–drug interactions by up to 300%, despite challenges including high implementation costs and regulatory compliance. The significance of upholding patient-centred care while encouraging technology innovation is emphasised in this review.

Pharmacy doi: 10.3390/pharmacy13020040

Authors: Christonikos Leventelis Aristidis S. Veskoukis Andrea Paola Rojas Gil Panagiotis Papadopoulos Maria Garderi Asimina Angeli Antzouletta Kampitsi Maria Tsironi

Buprenorphine and methadone are widely used as medication for addiction treatment (MAT) in patients with opioid use disorders. However, there is no compelling evidence of their impact on the immune–endocrine response. Therefore, the aim of this study was to examine the effects of the aforementioned medications on craving and on biomarkers of inflammation and cortisol, approaching the dose issue concurrently. Sixty-six patients (thirty-four under methadone and thirty-two under buprenorphine) who had just entered a MAT program and were stabilized with the suitable administered doses after a two-week process were divided into four groups based on medication dose (i.e., methadone high dose, buprenorphine high dose, methadone medium dose, and buprenorphine medium dose). The heroin craving questionnaire for craving assessment was completed, and the blood biomarkers were measured on Days 1 and 180. According to the results, high doses of both medications were accompanied by low levels of craving, cortisol, and inflammation on Day 1, and no alterations were observed on Day 180. On the contrary, medium doses reduced the tested psychosocial and biochemical parameters in terms of time, indicating a positive action for the patients. Concludingly, modifications in MAT doses are needed soon after the stabilization process to prevent inflammation and avoid relapse, thus helping opioid-addicted patients toward rehabilitation.

Pharmacy doi: 10.3390/pharmacy13020039

Authors: Marisa Marcath Kayla Craig Mary Beth O’Connell

In the United States, 41.6% of all pregnancies are unintended. This disproportionately affects women 20 to 24 years old. The high rate of unintended pregnancy among college students is associated with a lack of or incomplete formal education on reproductive health in grade and high school. The purpose of this study was to evaluate the outcomes of health education seminars designed to reduce reproductive health knowledge gaps among college-aged students and increase their safe sex behavior (health protection/prevention). Student pharmacists offered eighteen one-hour health education programs on fertility, contraception, and emergency contraception to college student attendees via live and Zoom-based presentations. Pre- and post-program quizzes, a post-program performance evaluation, and a post-program behavior change survey were completed anonymously. The response rate was 94.8% (n = 153 attendees). Post-program quiz scores (84%) were significantly higher than pre-program quiz scores (56%, p ≤ 0.001). The greatest increases in knowledge were about sperm survival, correct condom use, and fertility windows. The two-month follow-up survey responses revealed more confidence with birth control decisions, increased awareness of emergency contraception items, increased safe sex behaviors, and increased condom usage. Students reported that the seminars were helpful for preventing future unintended pregnancies. Reproductive health knowledge gaps can be minimized, and some self-reported safe sex behaviors can be improved with health education programs implemented at a university.

Pharmacy doi: 10.3390/pharmacy13020038

Authors: Michael Wilcock Dan Hearsey Mandy Slatter Neil Powell

Short-course antibiotic therapies for common infections treated in hospital are supported by national guidelines. Hospital clinicians’ knowledge of the course length recommendations for the management of common infections has not been fully explored. This study aims to assess doctors’ knowledge of and explores their opportunity and motivation for prescribing short-course therapy. A survey was emailed to all prescribers working in adult medical specialties in two hospitals in England. The survey responses from both hospitals were pooled before analysis. One hundred and sixty-five responses were provided. Knowledge of the recommended short course lengths was high overall, except for severe community-acquired/hospital-acquired pneumonia (CAP/HAP), with only 44% of respondents opting for shorter-course therapy. The majority did not believe longer courses were more effective than shorter courses. We identified a gap in prescriber knowledge for appropriate antibiotic course lengths for severe CAP/HAP. Addressing this gap may contribute to antimicrobial stewardship efforts to reduce course lengths in line with national guidelines.

Pharmacy doi: 10.3390/pharmacy13020037

Authors: Diane Ashiru-Oredope Roeann Osman Adeola H. Ayeni Eleanor J. Harvey Maria Nasim Emma Wright Christina Narh Uju Okereke Tasmin Harrison Christopher Garland Cecilia Pyper Andrew Evans Marion Bennie

Background: In the UK and globally, pharmacy professionals (pharmacists and pharmacy technicians) contribute to the delivery of local and national public or population health interventions. The existing literature on pharmaceutical public health predominantly focuses on micro-level activities, primarily describing community pharmacies delivering public health interventions to individuals. There is little-known evidence on pharmacy professionals’ involvement in delivering public health interventions at meso- (e.g., organisational) and macro (national/policy) levels, nor to what extent pharmacy professionals have specialist/advanced roles within public health practice. This study specifically explored pharmacy professionals’ specialist/advanced roles within public health as well as the opportunities and barriers to career development. The analyses of this mixed-methods study makes a series of important recommendations for future action. Methods: This study included two independent cross-sectional electronic surveys for pharmacy professionals and public health professionals, a call for evidence, and two workshops to develop recommendations. Results: Pharmacy professionals (n = 128) and public health professionals (n = 54) across the UK participated in the surveys. Most of the Pharmacy Professionals respondents were female (70%), pharmacists (85%), working in primary (33%) or secondary (25%) care settings, mainly based in England (75%), and most (63%) lacked formal public health qualifications although they were involved in a diverse range of public health interventions. The public health professionals were mostly females (67%), practicing in England (58%). Both professional groups identified opportunities and barriers to pharmacy professionals’ involvement in public health. Almost half of the public health professionals respondents (44%) stated that they had a pharmacy professional working as part of their current public health teams. Eighty-seven percent of public health professional respondents (45/52) agreed that having pharmacists or pharmacy technicians specialising in public health would be beneficial or very beneficial. Most of the documents, reports, and case histories provided through the call for evidence were unpublished. The workshops generated 94 recommendation statements, highlighting collaboration and the need to acknowledge pharmacy professionals’ contributions to public health. Conclusion: The recommendations for strategic action at meso- and macro-levels included three main themes: adopting a national strategic approach to pharmaceutical public health, including improving commissioning; formalising pharmaceutical public health workforce development; and promoting further evidence-based pharmaceutical public health research and development.

Pharmacy doi: 10.3390/pharmacy13020036

Authors: Ashim Malhotra Micah Buller Kunal Modi Karim Pajazetovic Dayanjan S. Wijesinghe

While pharmacy education successfully employs various methodologies including case-based learning and simulated patient interactions, providing consistent, individualized guidance at scale remains challenging in team-based learning environments. Artificial intelligence (AI) offers potential solutions through automated facilitation, but its possible utility in pharmacy education remains unexplored. We developed and evaluated an AI-guided patient case discussion simulation to enhance learners’ ability to integrate foundational science knowledge with clinical decision-making in a didactic immunology course in a US PharmD program. We utilized a large language model programmed with specific educational protocols and rubrics. Here, we present the step-by-step prompt engineering protocol as a toolkit. The system was structured around three core components in an immunology team-based learning activity: (1) symptomatology analysis, (2) laboratory test interpretation, and (3) pharmacist role definition and PPCP. Performance evaluation was conducted using a comprehensive rubric assessing multiple clinical reasoning and pharmaceutical knowledge domains. The standardized evaluation rubric showed reliable assessment across key competencies including condition identification (30% weighting), laboratory test interpretation (40% weighting), and pharmacist role understanding (30% weighting). Our AI patient simulator offers a scalable solution for standardizing clinical case discussions while maintaining individualized learning experiences.

Pharmacy doi: 10.3390/pharmacy13020035

Authors: Yasi Mojab Eunjoo H. Pacifici Terrence F. Graham Rory E. Kim Steven W. Chen

As medical devices become integral to modern healthcare, it is essential to prepare future pharmacists to counsel patients on device use and emerging therapeutic technologies. This study evaluates the impact of hands-on medical device training on pharmacy students at the University of Southern California (USC) Mann School of Pharmacy and Pharmaceutical Sciences, focusing on the level of comfort in counseling patients and retention of device-related information. Utilizing an active learning framework, this study provides insights into how experiential learning methods using medical devices enhance pharmacy students’ readiness for clinical practice. The results demonstrated significant improvement in levels of student comfort with counseling and information retention. The implementation of a hands-on training module has the potential to be adapted and applied to other courses or programs. The findings highlight the importance of integrating practical training within the pharmacy curriculum to better prepare graduates for effective patient education and support.

Pharmacy doi: 10.3390/pharmacy13020034

Authors: Aidan Snell Diana Lobaina Sebastian Densley Elijah Moothedan Julianne Baker Lama Al Abdul Razzak Alexandra Garcia Shane Skibba Ayden Dunn Tiffany Follin Maria Mejia Panagiota Kitsantas Lea Sacca

Background: Opioid analgesic therapy has been traditionally used for pain management; however, the variability in patient characteristics, complexity in evaluating pain, availability of treatment within facilities, and U.S. physicians overprescribing opioids have contributed to the current opioid epidemic. Despite large research efforts investigating the patterns of postsurgical pain management and influencing factors, it remains unclear how these overall trends vary across the varying sizes and available resources of academic hospitals, community hospitals, and outpatient surgery centers. The primary aim of this scoping review was to examine the patterns of contemporary postoperative pain management across healthcare settings, including academic medical centers, community hospitals, and outpatient surgery centers. Specifically, this study investigates how prescription practices for opioids, NSAIDs, and acetaminophen are influenced by patient demographics, including sex, race, gender, insurance status, and other social determinants of health (SDoH), to inform equitable and patient-centered pain management strategies. Methods: This study utilized The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and was used as a reference checklist. The Arksey and O’Malley methodological framework was used to guide the review process. To ensure comprehensive coverage, searches were conducted across three major databases: PubMed, Embase, and Cochrane Library. Results: A total of 43 eligible studies were retained for analysis. The highest reported Healthy People 2030 category was Social and community context (n = 39), while the highest reported category of SDoH was age (n = 36). A total of 34 articles listed sex and age as SDoH. Additional SDoH examined were race/ethnicity (n = 17), insurance (n = 7), employment (n = 1), education (n = 4), and income (n = 1). This review suggests that there are significant gaps in the implementation of institution-specific, patient-centered, and equitable pain management strategies, particularly in academic hospitals, which our findings show have the highest rates of opioid and NSAID prescriptions (n = 26) compared to outpatient surgical centers (n = 8). Findings from our review of the literature demonstrated that while academic hospitals often adopt enhanced recovery protocols aimed at reducing opioid dependence, these protocols can fail to address the diverse needs of at-risk populations, such as those with chronic substance use, low socioeconomic status, or racial and ethnic minorities. Conclusions: Findings from this review are expected to have implications for informing both organizational-specific and nationwide policy recommendations, potentially leading to more personalized and equitable pain management strategies across different healthcare settings. These include guidelines for clinicians on addressing various aspects of postoperative pain management, including preoperative education, perioperative pain management planning, use of different pharmacological and nonpharmacological modalities, organizational policies, and transition to outpatient care.

Pharmacy doi: 10.3390/pharmacy13020033

Authors: Maya Abo-Hamzy Kayla Antosz Sarah E. Battle Pamela Bailey Hana R. Winders P. Brandon Bookstaver Majdi N. Al-Hasan

The Centers for Disease Control and Prevention have been encouraging hospitals in the United States to report antimicrobial use (AU) to the National Healthcare Safety Network (NHSN). This retrospective cohort study examines the association between reporting AU and the Clostridioides difficile infection (CDI) standardized infection ratio (SIR) in South Carolina hospitals. Student’s t-test was used to examine the mean difference in the change in CDI SIRs from 2017 to 2021 between hospitals reporting AU for ≥3 years and those reporting AU for <3 years during the study period. Among 65 hospitals in South Carolina, 43 reported AU for <3 years, and 22 reported AU for ≥3 years. There was significantly greater decline in the CDI SIR from 2017 to 2021 in hospitals reporting AU for ≥3 years compared to those reporting AU for <3 years (mean difference of the change in the CDI SIR −0.33 [95% CI −0.57, −0.06]; p = 0.016). The results of a steeper decline in the CDI SIR in hospitals consistently reporting AU during the majority of the study period compared to other hospitals encourages hospitals to report AU to the NHSN and promotes antimicrobial stewardship efforts at the state and national level.

Pharmacy doi: 10.3390/pharmacy13020032

Authors: Christian J. Wiedermann Katia Sangermano Pasqualina Marino Dietmar Ausserhofer Adolf Engl Giuliano Piccoliori

This study investigated regional variations in the use of sedative psychotropic medications, often prescribed for insomnia, by comparing Italy and the culturally distinct Autonomous Province of Bolzano, South Tyrol. Using daily defined dose (DDD) data per 1000 inhabitants per day, benzodiazepines, Z-drugs, sedative antidepressants, and melatonin consumption from 2019 to 2023 were examined. The findings indicate a notably lower utilization of benzodiazepines in South Tyrol compared to the national Italian average, alongside a significant increase in sedative antidepressant use, particularly mirtazapine. These disparities likely stem from regional prescribing preferences influenced by cultural, linguistic, and healthcare system factors. While Z-drug consumption remained comparable across regions, melatonin use exhibited a gradual upward trend, albeit less pronounced in South Tyrol. These insights emphasize the necessity for region-specific strategies in optimizing insomnia treatment, balancing pharmacological approaches with non-pharmacological alternatives such as cognitive behavioral therapy for insomnia. Understanding these prescribing trends can inform healthcare policies aimed at reducing long-term sedative use while enhancing patient-centered care in sleep medicine.

Pharmacy doi: 10.3390/pharmacy13020031

Authors: Paul J. Wong Noam Morningstar-Kywi Rory E. Kim Tien M. H. Ng

The use of digital patient cases (eCases) is associated with student-perceived improvements in learning. However, novel instructional tools must demonstrate measurable student benefits to justify ongoing use. This research sought to identify the impact of digital patient cases (eCases) on student performance in a PharmD cardiovascular course. Optional eCases for hypertension (HTN), venous thromboembolism (VTE), and acute heart failure (AHF) were incorporated into the course. Performance on the exams and course overall was compared between student cohorts based on eCase use. Aggregated data were analyzed by year. Additional analysis was performed for scores on exam items related to eCase content. From 2020 to 2022, a total of 322/562 students (57.3%) used any eCase. While there were no differences in 2020 and 2021, eCase users in 2022 had significantly higher course (83.6% vs. 79.7%, p = 0.002) and final exam scores (75.0% vs. 67.7%, p < 0.001) compared with non-users. VTE eCase users had higher scores on VTE exam items compared to non-users, but only in 2021. AHF eCase users received higher scores on AHF exam items compared to non-users in 2021 and 2022. Among certain cohorts, student eCase use was associated with improved performance, and the use of certain eCases showed differences in content-specific performance. The eCase is a promising instructional tool that warrants further investigation to determine best design elements for maximal effectiveness.

Pharmacy doi: 10.3390/pharmacy13010030

Authors: Arinze Nkemdirim Okere Anthony Ryan Pinto Sandra Suther Patrick Ten Eyck

Approximately 2.8 million cases of bacterial antimicrobial resistance (AMR) infections result in over 35,000 deaths annually in the U.S. AMR is driven largely by inappropriate prescribing of antibiotics, especially in clinics serving rural communities or underserved populations. Antibiotic Stewardship Programs (ASPs) improve prescribing practices, but many rural clinics lack fully functional ASPs. This pilot study evaluated the impact of an algorithm-driven protocol on antibiotic prescribing in a rural primary care setting. We conducted a pre–post quasi-experimental study at a Federally Qualified Health Center (FQHC), focusing on upper respiratory infections, urinary tract infections, and sexually transmitted infections. Eligible patients were enrolled in the study during their primary care visits. The primary outcome was the frequency of guideline-concordant treatment, analyzed using descriptive statistics and Chi-square tests. Among 201 patients (101 pre-intervention, 100 post-intervention), the pre-intervention group consisted of 77% females and 47% African Americans, while the post-intervention group consisted of 72% females and 46% African Americans. The intervention was associated with a 12.6% decrease in the number of antibiotic prescriptions discordant with clinical guidelines (37.6% to 25%) from the pre- to post-intervention periods. This corresponded to an odds ratio of 0.55 (95% CI: 0.30–1.01, p = 0.054). Although not statistically significant at α = 0.05, this numerical decrease suggests potential benefits of algorithm-driven protocols in improving antibiotic stewardship in resource-limited settings. Longer study periods may further elucidate these benefits.

Pharmacy doi: 10.3390/pharmacy13010029

Authors: Jason W. Guy Shelby Smart Mollie Harber Julie H. Oestreich

Background: Mentorship has benefits for students and faculty, helping to support their professional development, connectedness, and career endeavors. While the value of mentorship programs is well documented in the literature, there is less practical guidance and few compiled resources to start a program. This paper reviews different mentorship practices in pharmacy education and provides a list of strategies to develop high-functioning mentorship programs or groups. Methods: A review of the literature was conducted through PubMed and other databases. If the titles and abstracts met the initial criteria for relevance to the topic, the complete article was reviewed in the context of the inclusion and exclusion criteria. Included articles focused on mentorship, mentorship programs, mentorship development, mentoring faculty or students, or mentoring in the workplace. Results: Twenty-three studies were included in the final review. Summaries and key points from the studies were reviewed and discussed. The advantages of mentorship programs include increased social connection, goal setting, and professional development. Challenges include increased time commitments and difficulty in determining objective markers of success. Critical components have been extracted from the literature, and key resources and templates have been provided to aid in mentorship program development. Conclusions: This review summarizes the pharmacy mentorship literature and provides user-friendly tables to quickly locate resources to build a mentorship program in pharmacy education.

Pharmacy doi: 10.3390/pharmacy13010028

Authors: Alison Doane Nicholas Cox Shannon Gadd Erin Gurney Payson Ashmead Kyle Turner

The University of Utah Clinical Innovation Fellowship models novel partnerships between third-party payers, clinical practices, and academia. While healthcare costs continue to increase unabated and physician burnout leads to provider shortages, this fellowship focuses on both crises by training pharmacists to establish new practices in ambulatory clinic spaces using funding provided by third-party payers. Not only does this fellowship represent a future in which pharmacists are able to address third-party payers’ need to reduce healthcare costs and clinics’ need to address provider shortages, it also successfully trained fellows to pursue jobs in ambulatory care and academia. Payers, clinics, providers and patients all expressed a high degree of satisfaction with the work of the fellows. In multiple clinics where fellows established new pharmacy services, those services led directly to new job approvals funded by the clinics themselves. The purpose of this paper is to serve as a model by which fellowship programs elsewhere can be designed, as well as to show that partnerships between ambulatory clinics, payers, and pharmacists are both sustainable and beneficial to all parties including, most importantly, the patients who receive better care for their complex chronic disease states. While this paper is descriptive in nature, work is ongoing to objectively measure the impact of the fellows on patients, providers, and third-party payers. A sampling of outcomes is presented, describing the impact of the pharmacist fellows’ efforts to improve medication management in primary care. Even with limited objective measures of success, we are able conclude that over the past 3 years, the fellowship has accomplished its aim of preparing fellows for future roles in ambulatory care, practice design, and academia while also demonstrating that a funding model aligning payers, clinics, and academia is sustainable.

Pharmacy doi: 10.3390/pharmacy13010027

Authors: Piangkwan Srimongkhol Sirirat Anutrakulchai Amponpun Theeranut Nonglak Methakanjanasak Sunee Lertsinudom

Background: The prevalence of chronic kidney disease (CKD) is rising, increasing demand for renal replacement therapy (RRT). Community pharmacies, as accessible healthcare hubs, can play a pivotal role in CKD prevention. This study aimed to develop care models for community pharmacies to optimize medication use, encourage behavior modification, and promote self-management among at-risk individuals. Methods: Conducted between June 2017 and July 2018, this study utilized an action research approach. Microalbuminuria was assessed using urine dipsticks, and pharmacists applied behavioral change and self-management support (SMS) strategies to slow CKD progression. Participants were categorized by albuminuria levels and enrolled in pharmacist-led care programs, with follow-up assessments at weeks 0 and 12. Results: Of 521 participants screened, 57% tested positive for albuminuria. For these individuals, serum creatinine testing and referrals to primary care were initiated. Self-management behavior assessment (S1) scores significantly improved (p = 0.024). Key factors associated with urine albumin levels included age < 60 years (OR = 0.44), diabetes (OR = 3.69), hypertension (OR = 2.01), BMI < 27.5 kg/m2 (OR = 0.42), eGFR ≥ 60 mL/min/1.73 m2 (OR = 3.34), lower systolic (OR = 0.55) and diastolic blood pressure (OR = 0.34), and fasting plasma glucose < 126 mg/dL (OR = 0.29). Conclusions: Community pharmacist-led albuminuria screening effectively supports CKD prevention and enhances self-awareness within communities.

Pharmacy doi: 10.3390/pharmacy13010026

Authors: Nantu Chakma Sunjida Binta Ali Md. Saimul Islam Tanisha Momtaz Noshin Farzana Raian Amzad Sharful Islam Khan Md. Iftakhar Hassan Khan Abul Kalam Azad Zaheer-Ud-Din Babar Aliya Naheed

Background: In 2015, the Directorate General of Drug Administration (DGDA) of Bangladesh accredited model pharmacies (MPs) to enhance the quality of pharmacy services across the country. We examined the challenges and opportunities for pharmacists in MPs, and also explored the perspectives of the pharmacy stakeholders for improving good pharmacy practices (GPPs) in Bangladesh. Methods: In-depth interviews (IDIs) were conducted with graduate pharmacists (Grade A) and diploma pharmacists (Grade B) recruited from a few selected MPs that were included in a previous study. Key informant interviews (KIIs) were conducted with the government and non-government stakeholders who were involved in pharmacy regulations and practices. Trained qualitative researchers conducted IDIs and KIIs using interview topic guides under relevant themes developed by the study investigators. Results: Between February and March 2021, nine Grade A and six Grade B pharmacists and nine government and non-government stakeholders were interviewed. The key challenges, as well as demotivational factors, for Grade A pharmacists were reported to be multiple responsibilities, inadequate salary, poor social status, an unfavorable working environment, long working hours, a lack of recognition, and low respect for their profession. However, Grade B pharmacists expressed job satisfaction, primarily due to working opportunities in reputable pharmacies and learning opportunities. The stakeholders reported a high operation cost of the MPs, a shortage of trained pharmacists, poor salary structures, and a lack of public awareness about the critical roles of the pharmacists in healthcare to be challenges of retaining Grade A pharmacists at the MPs. Addressing the challenges of the pharmacists and revising compensation packages along with strengthening monitoring systems would be important for improving GPPs at the MPs. Conclusions: This study has demonstrated that specifying the roles of the pharmacists, offering competitive packages, conducive working hours, and professional recognition would be imperative for the retention of trained pharmacists at MPs. Implementing regulatory standards and monitoring performance would enhance good pharmacy practices in Bangladesh.

Pharmacy doi: 10.3390/pharmacy13010025

Authors: Richard Cooper Catriona Matheson Emily Pagan Helen Radford

Opioid analgesic prescribing has increased significantly with associated concerns about dependence and overdose. This study aimed to explore non-cancer patients’ experiences and views of taking opioid analgesics to manage their pain. Twenty-two patients were purposively sampled from English GP practices and participated in semi-structured telephone interviews. Braun and Clarke’s thematic analysis was used to generate emerging latent and semantic themes. Patients resented taking opioid analgesics due to tolerance and addiction fears but were resigned to experiencing chronic pain. Control emerged in relation to patients’ acceptance of doctors’ control over treatment decisions but also patients’ attempted self-control over medicine adherence. This involved negatively perceived attempts to control pain but also prevent tolerance and addiction. Non-pharmacological treatments were viewed negatively by patients and addiction awareness arose from various sources. Patients were respectful of doctors but expressed negativity about the lack of addiction warnings, medication reviews and appointments. Family and friends were infrequently mentioned, as was reference to shared decision-making, suggesting patients navigate control over opioids and pain in relatively isolated ways. Patients reported generally negative experiences of opioid use for pain, which provides key insights for health professionals to enhance understanding and the management of such patients.

Pharmacy doi: 10.3390/pharmacy13010024

Authors: Alesha Smith Dhanya Hariharan Nair Emma R. Smith Tara F. Wheeler Lauren E. Smith Bruce R. Russell Carlo A. Marra

The University of Otago School of Pharmacy Clinic serves as a model for innovative medication management, tackling critical medication-related problems (MRPs) to enhance patient outcomes and advance pharmacy education. This study evaluated the clinic’s impact, examining 456 patient consultations over four years, with a focus on MRPs such as dosing errors, non-adherence, and inadequate monitoring. Using the DOCUMENT classification system, pharmacists identified 754 MRPs and issued 836 recommendations, primarily related to medication adjustments and monitoring. Patients reported significant improvements in health-related quality of life, as measured by the SF12V2 survey, with notable gains in mental and physical health metrics. This outcome highlights the clinic’s dual role in optimising patient care and providing pharmacy students with experiential learning opportunities. By integrating hands-on training within a supervised clinical environment, the clinic addresses workforce shortages and reinforces the value of pharmacist-led interventions. The findings advocate for university-based clinics as pivotal hubs for resolving MRPs through interprofessional collaboration, targeted interventions, and innovative technologies such as telepharmacy. The study underscores the need for expanded roles for clinical pharmacists in healthcare policy and practice, showcasing their potential to prevent medication errors, enhance lives, and reshape the future of pharmacy education and patient care.

Pharmacy doi: 10.3390/pharmacy13010023

Authors: Nadia Khartabil Ayda Awaness

Objective: The purpose of this review is to examine the potential role of donanemab-azbt in the treatment and management of early-stage Alzheimer’s disease (AD), with a focus on its efficacy, safety, and clinical relevance based on data from key clinical trials. Data Sources: A comprehensive literature search of PubMed was conducted using relevant keywords such as “donanemab”, “Alzheimer’s disease”, “Kisunla”, “TRAILBLAZER clinical trials”, and “amyloid-related imaging abnormalities (ARIA)”. Additional data were extracted from clinical trial records (clinicaltrials.gov), conference abstracts, and product monographs. Study Selection and Data Extraction: Only English-language studies conducted in human populations were included. Clinical trials and peer-reviewed studies detailing the efficacy, safety, and mechanistic insights of donanemab-azbt were prioritized. Data Synthesis: Key findings from the TRAILBLAZER series of clinical trials highlighted the potential of donanemab-azbt in slowing cognitive and functional decline in early-stage AD: (1) TRAILBLAZER-ALZ (Phase 2): This trial focused on participants with intermediate levels of tau protein. Results demonstrated a statistically significant slowing of cognitive and functional decline. (2) TRAILBLAZER-ALZ 2 (Phase 3): A large-scale, randomized, double-blind, placebo-controlled study confirmed the efficacy of donanemab-azbt in reducing amyloid plaque accumulation and cognitive decline. Key results included a 35% slowing of decline on the Integrated Alzheimer’s Disease Rating Scale (iADRS) and a 36% slowing on the Clinical Dementia Rating-Sum of Boxes (CDR-SB). Additional secondary outcomes showed improvements in activities of daily living and reduced risk of disease progression. (3) TRAILBLAZER-ALZ 3: This ongoing trial is evaluating donanemab’s potential in delaying or preventing Alois Alzheimer in cognitively normal individuals with amyloid plaques, broadening the scope of early intervention strategies. (4) TRAILBLAZER-ALZ 4: A head-to-head comparison with aducanumab revealed superior amyloid plaque clearance with donanemab. (5) TRAILBLAZER-ALZ 5: Currently recruiting, this trial aims to evaluate safety and efficacy across diverse populations with varying tau levels and comorbidities. (6) TRAILBLAZER-ALZ 6 (Phase 3b): This trial investigates modified dosing regimens to reduce ARIA while maintaining efficacy, particularly in populations with genetic risk factors like ApoE ε4 homozygotes. Relevance to Patient Care and Clinical Practice: Donanemab-azbt represents a promising treatment option for patients with early-stage AD. It specifically targets and reduces amyloid beta plaques, a hallmark of the disease, potentially slowing progression and preserving cognitive function. However, its administration requires careful patient selection, including genetic testing for ApoE ε4 status, to mitigate risks of ARIA. Furthermore, the findings emphasize the importance of close monitoring during treatment. Conclusions: Donanemab-azbt offers a new avenue for managing early-stage AD, showing promise in reducing amyloid burden and slowing cognitive decline. While its efficacy and safety have been demonstrated in clinical trials, further research is essential to validate long-term outcomes, assess effectiveness across diverse populations, and refine dosing strategies to minimize side effects. With continued investigation, donanemab-azbt could significantly impact the clinical landscape of AD treatment.

Pharmacy doi: 10.3390/pharmacy13010022

Authors: Alexandra Porlier Pierre-Yves Gagnon Valérie Chénard Marc Veillette Nicolas Bertrand Caroline Duchaine Chantale Simard Beno?t Drolet

Background: Pembrolizumab is a monoclonal antibody (mAb) approved for treating Non-Small Cell Lung Cancer (NSCLC), melanoma and lymphomas. Commercialized in single-size (100 mg/4 mL) vials, the pembrolizumab solution contains no preservative. As such, the manufacturer recommends using pembrolizumab vials only once, and thus, to rapidly dispose of any unused portion. Thus, appreciable amounts of this costly product are wasted. Objective: To evaluate the physical, chemical and microbiological stability of pembrolizumab vial leftovers stored at room temperature or at 4 °C, 7 and 14 days after first vial puncturing. Methods: Following pH assessments, submicronic aggregation and turbidity of pembrolizumab were measured by dynamic light scattering (DLS) and spectrophotometry, respectively. In addition, SE-HPLC (size-exclusion high-performance liquid chromatography), IEX-HPLC (ion exchange HPLC) and peptide mapping HPLC served to respectively evaluate aggregation and fragmentation, distribution of charge and primary structure of pembrolizumab. Incubation at 37 °C for 48 h of pembrolizumab vial leftovers on blood agar plates was used to determine their microbiological stability. Results: Physical, chemical and microbiological stability of pembrolizumab leftovers was demonstrated for at least two full weeks. Conclusions: These results argue forcefully in favor of allowing prolongation of pembrolizumab vial leftovers usage well beyond a single day.

Pharmacy doi: 10.3390/pharmacy13010021

Authors: Kathryn King Wladyslawa Czuber-Dochan Trudie Chalder Christine Norton

Inflammatory bowel disease (IBD) is treated with medications to induce and maintain remission. However, many people with IBD do not take their prescribed treatment. Identifying factors associated with IBD medication adherence is crucial for supporting effective disease management and maintaining remission. Quantitative and qualitative studies researching IBD medication adherence between 2011 and 2023 were reviewed. In total, 36,589 participants were included in 79 studies. The associated non-adherence factors were contradictory across studies, with rates notably higher (72–79%) when measured via medication refill. Non-adherence was lower in high-quality studies using self-report measures (10.7–28.7%). The frequent modifiable non-adherence risks were a poor understanding of treatment or disease, medication accessibility and an individual’s organisation and planning. Clinical variables relating to non-adherence were the treatment type, drug regime and disease activity. Depression, negative treatment beliefs/mood and anxiety increased the non-adherence likelihood. The non-modifiable factors of limited finance, younger age and female sex were also risks. Side effects were the main reason cited for IBD non-adherence in interviews. A large, contradictory set of literature exists regarding the factors underpinning IBD non-adherence, influenced by the adherence measures used. Simpler medication regimes and improved accessibility would help to improve adherence. IBD education could enhance patient knowledge and beliefs. Reminders and cues might minimise forgetting medication. Modifying risks through an adherence support intervention could improve outcomes.

Pharmacy doi: 10.3390/pharmacy13010020

Authors: Omolola A. Adeoye-Olatunde Tessa J. Hastings Michelle L. Blakely LaKeisha Boyd Azeez B. Aina Fatimah Sherbeny

Background: The older adult population is rapidly expanding in the United States (US), with a high prevalence of high blood pressure, high cholesterol, and diabetes. Medication nonadherence is prevalent in this population, with less evidence on the influence of social determinants of health (SDoH). Thus, the objective of this study was to identify and prioritize SDoH associated with medication adherence among US older adults with these comorbidities. Method: Using the World Health Organization Commission on Social Determinants of Health and Pharmacy Quality Alliance Medication Access Conceptual Frameworks, publicly available National Health and Nutrition Examination Survey datasets (2009–2018) were cross-sectionally analyzed among respondents aged 65 and older who were diagnosed with study diseases. Data analyses included descriptive statistics, and logistic regression using an alpha level of 0.05. Result: Analyses included 5513 respondents’ data. Bivariate analysis revealed significant differences in medication adherence based on several structural (e.g., ethnicity) and intermediary (e.g., disability status) determinants of health. Multivariable analysis revealed significant differences in medication adherence for alcohol consumption (p = 0.034) and usual healthcare place (p = 0.001). Conclusions: The study findings underscore pertinent implications for public health and policy, with specific SDoH being the most likely to affect medication adherence in common chronic conditions among older adults in the US.

Pharmacy doi: 10.3390/pharmacy13010019

Authors: Sherry Huinan Xia Megha Mohan Narayanan Venkatesh Swamy Kari Franson

Prescription digital therapeutics (PDTs) are emerging as a pivotal component of digital healthcare, providing software-based therapies for various diseases. This review aims to analyze the regulatory landscape in the U.S., safety, efficacy, and current challenges of PDTs, focusing on mental health conditions. Relevant articles were searched on PubMed, Google Scholar, ClinicalTrials.gov, and FDA Guidance Documents databases, supplemented by manual searches of reference lists from included studies. Inclusion criteria covered English-language studies on the development and application, therapeutic efficacy, and regulatory guidelines of PDTs in mental health. Data extraction and synthesis were conducted to summarize key findings and trends in the literature. FDA regulatory frameworks for PDTs are evolving through pathways of de novo and 510(k) applications, with patient-centric guidance. Clinical trials and real-world data support PDTs’ safety and efficacy, while highlighting regulatory needs. Challenges include payer coverage, patient accessibility, and data privacy concerns. Mixed patient feedback reveals areas for improvement. Limited healthcare provider engagement and payer coverage contributed to financial challenges for PDT manufacturers. Future trends suggest that PDTs will expand beyond mental health. The evolving landscape underscores the need for continued research, regulatory refinement, and collaborative efforts across stakeholders to ensure the successful integration of PDTs into healthcare.

Pharmacy doi: 10.3390/pharmacy13010018

Authors: Axel Maurice-Szamburski Cyril Quemeneur Romain Rozier Philippe Cuvillon Claude Ecoffey

Intravenously administered nonsteroidal anti-inflammatory drugs (NSAIDs) constitute a crucial component of multimodal analgesia strategies in surgical settings. This narrative review aims to provide an up-to-date evaluation of the efficacy, safety, and clinical use of intravenous (IV) NSAIDs for perioperative pain management in adults and children. The NSAIDs and selective COX-2 inhibitors (coxibs) approved in Europe for the short-term symptomatic treatment of acute, moderate perioperative pain via IV infusion in adults and/or children have been influenced by US and global guidelines and practice: the drugs primarily reviewed here are ibuprofen, ketorolac, ketoprofen, naproxen, paracetamol, and acetylsalicylic acid. Furthermore, intravenous ibuprofen is authorized for the short-term symptomatic treatment of fever. In contrast to intravenous ketoprofen, intravenous ibuprofen is authorized for administration to children over 6 years of age or weighing more than 20 kg. Overall, IV ibuprofen had a more favorable profile with regard to peri- and postoperative opioid sparing and pain relief. Oral ibuprofen and IV ibuprofen have similar levels of efficacy, although IV ibuprofen has a shorter onset of action and is required in patients who are unable to take oral medications. The frequency of significant adverse events appears to be similar for ibuprofen and paracetamol. Systematic reviews and meta-analyses report that intravenous NSAIDs reduce postoperative opioid consumption by approximately 20–60%, improving pain management with fewer opioid-related side effects. In indications in infants, the choice of medication is limited, and the oral route is not always feasible; IV formulations of ibuprofen are preferred in this setting. Topics for further research should include head-to-head trials of IV NSAIDs.

Pharmacy doi: 10.3390/pharmacy13010017

Authors: Masatsugu Sato Shiho Fujita Masahiko Kimura Ken Takeuchi Yukihiro Hamahata Yoshikazu Matsuda

Prolonged working hours among physicians in Japan, alongside rising inflammatory bowel disease (IBD) cases, have heightened the need for additional support in IBD care. Protocol-based pharmacotherapy management (PBPM) has emerged as an effective approach that allows pharmacists to assist in prescription management under predefined protocols, potentially reducing physicians’ workload. However, the detailed process of formulating PBPMs remains unclear. This study developed effective PBPM protocols by reviewing past provisional prescriptions. Provisional prescriptions made by pharmacists based on verbal instructions from physicians were reviewed to develop new PBPMs at Tsujinaka Hospital, Kashiwanoha. We retrospectively analyzed the PBPM application rate during three months before and after this initiative based on the proportion of prescriptions processed under standard procedure (SP), pharmacist provisional prescribing (PPP), and PBPM (PBPM-P). A total of 1259 prescriptions were retrospectively analyzed in this study. Before the initiative, there were 586 prescriptions (oral/topical, 128; injection, 458); after the initiative, there were 673 prescriptions (oral/topical, 242; injection, 431). The pre-initiative rates for SP, PPP, and PBPM-P were 68.3%, 30.7%, and 1.0%, respectively. Post-initiative, the rates were 48.3%, 26.6%, and 25.1%, respectively. A significant decrease was observed in the proportion of SP and PPP, while PBPM-P showed a significant increase after the initiative. Specifically, the proportion of PBPM-P increased by 24.1 percentage points, reflecting its broader adoption. In terms of safety, the proportion of pharmacists’ prescription questions decreased significantly from 3.1% before to 0.3% after the initiative. Additionally, the proportion of prescription changes resulting from these questions decreased significantly, from 1.2% to 0%. The PBPM development process evaluated here could successfully form effective PBPMs, which have the potential to reduce physicians’ workload, indicating that the process detailed in this study could be applied to future protocol development.

Pharmacy doi: 10.3390/pharmacy13010016

Authors: Nikolaos Kotsiou Paschalis Evangelidis Michail Bolios Konstantinos Tragiannidis Panagiotis Kalmoukos Zacharo Ntova Sofia Chissan Sofia Vakalopoulou Eleni Gavriilaki

This study evaluates the health-related quality of life (HRQoL) among patients with hemophilia A currently undergoing prophylactic treatment at the Hemophilia Center of Northern Greece. Using the Haem-A-QoL questionnaire, we assessed various HRQoL dimensions in a cohort of 29 adult male patients, analyzing the impact of age, disease severity, and treatment regimens. The results revealed that younger patients (18–30 years old) exhibited significantly better overall HRQoL scores (total score of 25.36) compared to older age groups (37.81 for the 31–45 group and 43.71 in the 45+ group), particularly in the physical health (29.16 vs. 48.43 vs. 58.57) and mental well-being domains (25 vs. 37.11 vs. 41.07). Interestingly, moderate hemophilia patients reported lower HRQoL (42.31) than those with severe form (34.85), suggesting unique challenges in managing their condition. The ’Sports/Free Time’ domain had the highest scores (65.81), indicating significant limitations in physical activities in the everyday lives of affected individuals. However, better outcomes were observed in the mental dimension (36.09), work/study (34.88), family planning (10.68), and relationships aspects (16.67), where our cohort reported very low scores compared to similar studies, indicating a significantly better quality of life in these domains. These findings highlight the importance of personalized psychosocial support and targeted interventions to address the specific needs of hemophilia patients, particularly in enhancing physical activity opportunities and managing the psychological burden of moderate hemophilia. The study contributes valuable insights into the HRQoL of hemophilia patients and underscores the necessity for tailored approaches to improve patient outcomes across all dimensions of life.

Pharmacy doi: 10.3390/pharmacy13010015

Authors: Stefano Scotti Lorenza Scotti Federica Galimberti Sining Xie Manuela Casula Elena Olmastroni

Polypharmacy, defined as the concurrent use of multiple medications, increases the risk of various adverse outcomes. However, the variability in definitions across the literature contributes to substantial heterogeneity. Building on the published literature, this study aimed to identify a set of operational definitions of polypharmacy applicable to administrative databases and to assess their association with all-cause hospitalization. Data from the pharmacy refill and hospitalization databases of the Local Health Unit (LHU) of Bergamo, Lombardy, were analyzed. Patients aged ≥40 with at least one reimbursed drug prescription in 2017 were included. Prescription coverage was evaluated using total defined daily doses (DDDs), and all-cause hospitalizations from January to June 2018 were considered. Definitions explored included (i) the WHO’s criterion of ≥5 medications by ATC fourth-level code; (ii) the exclusion of prescriptions usually for short-term treatments; and (iii) drugs with cumulative annual DDD ≥ 60. Approaches were assessed annually, quarterly, and monthly, and logistic regression was used to estimate odds ratios (ORs) for hospitalization risk. Among 431,620 patients, the DDD ≥ 60 definition showed the least variability (20.47–21.16%) and identified an older more complex cohort. All definitions showed a dose-dependent association with hospitalization risk. Different definitions of polypharmacy result in varying prevalence, with DDD ≥ 60 being the most consistent. A patient-centric approach is crucial to assess the appropriateness of polypharmacy.

Pharmacy doi: 10.3390/pharmacy13010014

Authors: Anna Bollinger Melissa Semedo Fortes Henriette E. Meyer zu Schwabedissen Kurt E. Hersberger Céline K. St?uble Samuel S. Allemann

Pharmacogenetic (PGx) testing is a promising approach for optimizing drug therapies. However, there is limited knowledge regarding its real-world utilization and long-term impact in clinical practice. This study assessed how often PGx information informs treatment decisions and evaluated patients’ perspectives on its use and non-use, identifying enablers for PGx implementation. A mixed-methods study was conducted with 24 patients with a median of 1 year after PGx testing. Medication and health-related data were collected at enrollment and at the follow-up 1 year later using a semi-structured questionnaire. At the follow-up, 62 medication changes were identified in 18 patients. A median of four medication changes per patient were initiated mainly by medical specialists (58%). PGx information was considered for 15 patients in 39 medication changes (63%). Patient-reported factors contributing to the non-use of PGx information included a lack of knowledge and interest among healthcare professionals (HCPs), structural and administrative barriers, and an over-reliance on patient advocacy. Potential enablers should address targeted PGx education, interprofessional collaboration, awareness among policymakers, and concise recommendations focused on PGx-actionable drugs from testing providers. By implementing these interdependent enablers, PGx can evolve into a long-term, clinically integrated cornerstone of individualized pharmacotherapy.

Pharmacy doi: 10.3390/pharmacy13010013

Authors: Susan Williams Marissa A. Iannuzzi Sarah J. Prior

Background: Parkinson’s disease (PD) is a neurodegenerative disorder that is predominantly controlled through pharmacotherapy. People with PD have highly complex medication regimens that are often poorly managed during hospital admissions. This project aims to understand the issues experienced by patients with PD and healthcare staff that impacted their medication management during their hospital admission at a tertiary metropolitan hospital in New South Wales, Australia. Methods: This project focuses on the mixed-methods diagnostics phase of the healthcare redesign approach to health service improvement, utilising organisational data, online surveys, interviews, and focus groups. Results: The findings from this project highlight key areas to address to improve the medication management of patients with PD admitted to hospital. The organisational data (n = 222) showed that the identification of PD patients, untimely medication reviews, prescribing errors, and untimely medication administration all contributed to poor patient experience. The staff surveys (n = 81) highlighted that a lack of knowledge of PD medications and poor patient identification impacted patient experience. The patient surveys (n = 18) and patient interviews (n = 16) suggested that confidence around medication management and administration timing could be improved. Conclusions: Poor PD medication management in hospital impacts the patient experience and should be improved to ensure better outcomes for patients and the health services.

Pharmacy doi: 10.3390/pharmacy13010012

Authors: Abbas Al Mutair Alya Elgamri Kawther Taleb Batool Mohammed Alhassan Mohamed Alsalim Horia Alduriahem Chandni Saha Kawthar Alsaleh

Technology has increasingly influenced the provision of healthcare services by enhancing patient safety, optimising workflows, and improving efficiency. Large healthcare facilities have adopted automated dispensing cabinets (ADCs) as an advanced technological solution. A key gap exists in understanding the ADC implementation experience in different contexts. Therefore, this study seeks to fill this literature gap by exploring key stakeholders’ perspectives on the benefits, barriers, and improvement opportunities related to ADCs, offering valuable insights to support their effective integration across various healthcare settings. This qualitative study was conducted in Saudi Arabia. The implementation of ADCs generally has positive outcomes for all staff. The system has brought about enhanced medication tracking, greater time efficiency, along with reduced workload and medication errors. However, there are barriers to their implementation, including changes in workflow and workload distribution, cabinet design, technical medication management challenges, and the need for staff training. To maximise the effectiveness of ADCs, healthcare organisations should focus on improving operational workflows, providing ongoing staff training, and maintaining robust system monitoring. Additionally, manufacturers should focus on advancing technology to further enhance the efficiency and functionality of ADCs.

Pharmacy doi: 10.3390/pharmacy13010011

Authors: David Le Maya Saba Habib Bhurawala Muhammad Aziz Rahman Smita Shah Bandana Saini

Vaping, particularly the use of nicotine vaping products (NVPs), has emerged as a public health concern. The regulatory environment surrounding NVPs in Australia has rapidly evolved, shifting from a prescription-only model to availability through community pharmacies. Pharmacists play a critical role in addressing vaping-related health concerns. This study explores Australian pharmacists’ perspectives on their professional roles and the support needed to manage vaping-related enquiries. Qualitative semi-structured interviews were conducted with 25 practicing pharmacists using a topic guide developed from the current literature and team expertise. The interviews were transcribed verbatim and analysed thematically using an inductive approach to identify key themes. Key themes included risk perception, professional vaping health-related services, professional practice and other support-related needs. Pharmacists expressed significant uncertainty about the risks and harms associated with vaping. There was apprehension around the regulatory complexity of supplying NVPs, and participants called for greater education and support, particularly around NVP’s place in smoking cessation and potential vaping cessation services. Effective public health messaging and risk communication about vaping are crucial. At the centre of recent legislative changes, pharmacists require training and professional support to address vaping-related scenarios and provide counselling that aligns with individual risk perceptions, ensuring NVP use is clinically appropriate.

Pharmacy doi: 10.3390/pharmacy13010010

Authors: Lavinia Salama Karen Suchanek Hudmon Leena Myran Nervana Elkhadragy

Pharmacists are often the first point of contact for healthcare advice in rural communities, where access to healthcare is limited. Tobacco cessation rates improve with counseling from a pharmacist, and in many states, pharmacists can now prescribe medications for quitting. This study aimed to explore smoking behavior and cessation motivations among patients at a Federally Qualified Health Center (FQHC) clinic in rural Wyoming, estimate the prevalence of tobacco-related interventions by clinic staff, and assess patients’ interest in engaging in pharmacist-led cessation programs. A cross-sectional survey was administered over three months to clinic patients who self-identified as current tobacco users. Survey items assessed sociodemographics, tobacco use and vaping behaviors, previous cessation advice from pharmacists, and interest in pharmacist-led support for quitting. Of 63 respondents, 57 (90.5%) reported current tobacco use. Most were ready to quit within the next month (43.9%) or the next six months (33.3%), and 26.3% had previously received advice about quitting from a pharmacist. Most (59.6%) expressed interest in establishing care with a pharmacist for cessation support, and 45.3% requested to be contacted by a pharmacist for assistance with quitting. Interest did not differ by gender or age. The results indicate that rural patients are interested in engaging with pharmacists for quitting. Further research is needed to determine how pharmacy-led programs can complement existing healthcare resources to improve access to cessation support in underserved areas.

Pharmacy doi: 10.3390/pharmacy13010009

Authors: Clara Baudart Thomas Briot

Purpose: The COVID-19 pandemic led to a major interest in ultraviolet C (UVC) disinfection devices and accelerated the implementation of UVC devices in healthcare facilities due to their proven efficacy in the inactivation of various pathogens. While UVC technology offers several advantages, some drawbacks remain. This report, drawing on studies, guidelines, and practical experiences related to the use of UVC technology in healthcare settings, examines the efficacy, advantages, and drawbacks of UVC devices, and their applications in aseptic drug-compounding pharmaceutical units. Summary: Studies, guidelines, and practical experiences were selected. UVC technology offers advantages such as rapid disinfection, reduced reliance on chemical agents, minimal waste, and freedom from manual disinfection variability, making it particularly valuable for maintaining aseptic conditions in compounding environments. However, some drawbacks persist, as it is a germ-dependent method and there is currently no standardized method for ensuring effectiveness. Conclusions: This opinion paper highlights the effectiveness of UCV technology in pharmaceutical compounding units, proving that it is a viable alternative to the traditionally used manual and operator-dependent methods. However, there is a need for standardized methods to evaluate UVC devices.

Pharmacy doi: 10.3390/pharmacy13010007

Authors: Iasmina-Alexandra Predescu Alex-Robert J?jie Dalia P?tra?cu Aida-Luisa-Vanessa Pasc Elisaveta-Ligia Piro? Cristina Trandafirescu Cristian Oancea Cristina Adriana Dehelean Elena-Alina Moac?

The complexities surrounding the use of medications, substance abuse, and the recreational use of plants are multifaceted and warrant a comprehensive examination. This review highlights the complexities surrounding the consumption of chemical substances in excess or for non-medical purposes, obtained through legal prescriptions, over-the-counter purchases, or illicit means, with an emphasis on the predictive role of stressors and individual-level variables in the development of substance use disorders, as well as the influence of the regulatory environment on patterns of consumption. Additionally, the alarming escalation in the mortality rate associated with illicit drug and opioid overdoses is also underscored. The recreational use of prescription medications can lead to significant health risks, particularly when combined with other substances; therefore, the need for interventions and preventive measures to address substance abuse among various populations is imperative. Furthermore, novel insights on substance abuse addiction, exploring the neurobiological mechanisms underlying addiction, and discussing treatment approaches and interventions are elucidated. Advancements in technology for detecting substance abuse are also highlighted, displaying innovative tools for more effective identification and monitoring. In conclusion, the complexities of medications, substance abuse, and the recreational use of plants reveal a landscape marked by overlapping motivations and health implications. The distinction between medical and recreational use is critical for understanding user behavior and addressing public health concerns.