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Background: Package leaflet provides information about medicinal product to the user. Printed leaflet is familiar and available, however poorly legible, especially when containing multiple languages. It is resourceful to update, has potential to go missing or get damaged, and is environmentally burdensome. The pharmaceutical manufacturers in the Baltic countries have been granted permission to market selected hospital medicinal products without printed package leaflet. The industrial pilot project is expected to promote availability of medicinal products and patient safety via increased access to medicinal information., Objective: Only few countries in Europe have derogated from Article 58 of Directive 2001/83/EC. Knowledge about the effects of removal of paper package leaflet from the medicinal product is limited, and related publications are scarce. Current interview study is identifying the obstacles during the implementation of the industrial project, investigating the potential environmental impact, and searching for further opportunities for the package leaflet in development of medicinal products., Methods: Real-time person-to-person semi-structured interviews with relevant stakeholders were conducted, and transcripts were analysed by content analysis to identify themes., Results: Results demonstrated general support for removing package leaflet from selected hospital products. Main difficulties of the industrial project regarded the need for clear communication and practical disadvantages of project setup. Main benefits included educational aspect of increasing awareness about product information and strengthened collaboration. Majority of participants felt doubtful about the impact of the industrial project on people's awareness of ecological issues and they admittedly lacked sufficient information on the environmental impact of pharmaceutical packaging., Conclusion: The removal of paper leaflet could be extended to more products based on the positive feedback for the industrial pilot project. However, it is paramount that the format of electronic product information would need to be enhanced first to improve readability., Competing Interests: None., (© 2022 The Authors.)

Interrogating the literature is among the first steps a researcher undertakes when actuating a research project or also when any scholar might seek to know what has been done in an area, best practices for conducting a certain activity, or simply to seek answers for a question ranging from one's own personal curiosity to those that might affect departmental or institutional guidance. Decisions on the type of review process to undertake is one that is not taken lightly. This methods commentary outlines the reasons for conducting a scoping review versus a systematic review for topics related to pharmacy education. Considerations for conducting the scoping review are outlined including considerations for writing a protocol prior to conducting a scoping review, to potential platforms to use for transparency of sharing data, processes related to guidelines for data extraction and types of search strategies utilized., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The author is an Editorial Board Member/Editor-in-Chief/Associate Editor/Guest Editor for [Journal name] and was not involved in the editorial review or the decision to publish this article. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: As mentioned above, I am an Associate Editor for ERCSP and lead author on this methodology paper. Shane is the Editor for ERCSP and is the second author for this paper. This paper will go out for review as does every paper. I have no financial competing interests for this paper and the work conducted., (© 2024 The Author(s).)

This study conducts a bibliometric analysis of academic papers and conference proceedings related to tablet dispensers, medicine dispensers, and pill dispensers within the framework of Sustainable Development Goal 03: Good Health and Well-Being. The analysis spans literature published between 1997 and 2023. Utilizing the Web of Science database, the study employs keywords such as "tablet dispenser," "medicine dispenser," and "pill dispenser" to gather relevant English-language papers classified as Proceeding Papers or Articles. The inclusion and exclusion criteria filtered 79 initial records down to 40, focusing on articles pertinent to SDG 03. Data analysis was performed using the Biblioshiny App through RStudio, examining publication trends, authorship patterns, citation networks, and other bibliometric indicators. The findings reveal a steady increase in research output, moderate citation impact, extensive references, and collaborative authorship, with limited international collaboration. The study underscores the growing interest and research activity in robotic tablet dispensing machines for elderly care while highlighting areas for further global engagement., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 The Authors.)

Introduction: Schizophrenia is a chronic mental disorder that requires long-term treatment, particularly antipsychotic medications. However, medication adherence among patients with schizophrenia is often suboptimal, leading to symptom relapse and poor outcomes. The Si-Care (Schizophrenia Care) program was developed as a pharmacist-led home intervention to improve medication adherence and support symptom control in patients with schizophrenia. This study aimed to evaluate the effectiveness of the Si-Care intervention in improving medication adherence and maintaining stability of symptoms among schizophrenia patients., Methods: A quasi-experimental study was conducted in three community health centers or Puskesmas in Banjarmasin, Indonesia. A total of 57 participants were recruited according to the sampling criteria. The Si-Care intervention consisted of seven home visits by trained pharmacists over four months, providing education, counseling, and medication monitoring. Adherence to medication was evaluated using the pill count method and severity of symptoms was measured using the Positive and Negative Syndrome Scale (PANSS) pre- and post-intervention. Data were analyzed using the Friedman test for adherence and the Wilcoxon test for PANSS scores., Results: Mean medication adherence improved significantly from 77.38 % ± 25.85 at baseline (T0) to 97.57 % ± 11.09 at the final visit (T4) ( p  = 0.000). However, the decrease in PANSS scores from 38.03 ± 9.14 to 37.81 ± 9.15 was not statistically significant ( p  = 0.089). Despite the lack of significant change in PANSS scores, symptoms remained stable throughout the intervention, suggesting effective symptom management., Conclusions: The Si-Care intervention significantly improved medication adherence among people with schizophrenia, contributing to the maintenance of stable symptoms. Pharmacist-led home interventions provide valuable support to address adherence challenges and should be considered a critical component in schizophrenia care. Future studies should consider a more rigorous design, a larger sample size, and longer follow-up to better evaluate the sustainability, scalability, and applicability of the intervention in diverse healthcare settings., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Inc.)

Background: Artificial intelligence (AI) has a significant potential to impact pharmacy practices worldwide. This study investigates pharmacists' perceptions of AI's role in pharmacy practices, their willingness to adopt it, and perceived barriers to its implementation at community pharmacies in Ethiopia., Methods: A cross-sectional study was conducted among community pharmacists in Ethiopia. Data were collected using a self-administered questionnaire. Independent samples t -test, one-way ANOVA, and post-hoc analyses were used to compare pharmacists' perception and willingness scores. A linear regression analysis examined the association of independent variables with pharmacists' perception of AI and willingness to utilize AI. A p -value <0.05 was considered statistically significant., Results: Of 241 pharmacists approached, 225 (93.3 %) completed the survey. Overall, about two-thirds (67.1 % and 66.2 %) of community pharmacists had a high level of perception and willingness to use AI applications in pharmacy, respectively. Pharmacists with bachelor's degrees and above (β = 2.76: 95 % CI: 0.09, 5.01 vs. β = 1.79: 95 % CI: 0.05, 4.21), those who utilized scientific drug information sources (β = 2.45, 95 %: 0.17, 4.45 vs. β = 1.76, 95 % CI: 0.91, 3.89), pharmacists who had a previous exposure of AI (β = 1.02, 95 %: 0.03, 3.24 vs. β =1.13, 95 % CI: 0.07, 2.93), and those who with higher perceived AI knowledge (β =1.09, 95 % CI: 0.02, 2.46 vs. β = 1.14, 95 %CI: 0.17, 3.11) had significantly higher perception of AI and willingness to utilize it, respectively compared to their counterparts. Lack of internet availability (89.3 %), lack of AI-related software/hardware (88.2 %), and limited training (80.9 %) were the most frequently reported barriers by pharmacists to AI adoption. Over 90 % of pharmacists agreed on the importance of internet availability (93.3 %), policies/frameworks (91.6 %), and research/learning from others (89.3 %) for successful AI integration., Conclusion: Despite positive perceptions and willingness from pharmacists, AI implementation in community pharmacies could be hindered by resource limitations, training gaps, skill constraints, and infrastructure issues. To facilitate adoption, enhancing knowledge and skills, and developing policies/frameworks are crucial., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: The study of over the counter (OTC) vending machines is crucial given their growing popularity and potential impact on the pharmaceutical industry and consumer behaviour., Objectives: This study involves a bibliometric quantitative analysis of academic literature to evaluate OTC vending machines in terms of their evolution, current trends, and potential areas for future research ., Methods and Materials: The Scopus database was searched using its advanced search tool, focusing on papers that included the search query in their titles, abstracts, and keywords. Data analysis included bibliometric indicators such as publication counts, citation trends, and co-authorship networks, which were visualized using VOSviewer software (version 1.6.20) to highlight key research themes and collaboration patterns., Results: A total of 399 publications on OTC vending machines were found between 1833 and 2024. Over the last 20 years, there has been an annual increase in the number of publications related to OTC vending machines, rising from 1 in 2001 to 31 in 2023. The United States ( n  = 118; 29.57 %) led in productivity, followed by the United Kingdom (45; 11.27 %), India (30; 7.51 %), Australia (27; 6.76 %), Canada (16; 4 %), Italy (15; 3.75 %), and China (15; 3.75 %). A total of 35 institutions have been involved in research on OTC vending machines. The Dubai Municipality contributed the highest percentage of articles ( n  = 3, 0.75 %), followed by the Emirates Health Services (n = 3, 0.75 %), Al Ain University ( n  = 2, 0.5 %), and Baystate Medical Center (n = 2, 0.5 %). Before 2016, much of the research on OTC vending machines focused on terms related to healthcare policy and health promotion, indicating the early exploration of this field. Present trends highlight terms associated with pharmacy practice, such as pharmacists, pharmacy, and prescription-related subjects., Conclusions: This study emphasises the practical necessity for enhanced regulatory structures to mitigate risks such as medication abuse, unfavourable drug interactions, and incorrect dispensing practices. Additionally, the study highlights the need for interdisciplinary collaboration among technologists, policymakers, and healthcare professionals to maximize the benefits of OTC vending machines while addressing consumer behaviour and safety issues., Competing Interests: All authors declare that they have no conflict of interest., (© 2024 The Authors.)

Background and Objectives: Heart disease and diabetes are leading causes of death in the U.S., with timely screening, referrals, and education being critical for effective treatment. The Community-based Valued-driven Care Initiative (CVCI) aimed to develop, implement, and evaluate the feasibility of delivering patient-centered care interventions for high priority disease states in community pharmacies. This article focuses specifically on two of the selected interventions, both of which were screening and referral (S&R) programs for the prevention and treatment of cardiovascular disease (CVD) and diabetes (DM) respectively. This exploratory evaluation was designed as an effectiveness-implementation hybrid Type II study. Its objectives were to assess both implementation and preliminary program effectiveness using mixed data., Methods: Fifteen community pharmacies opted to implement one of the two programs over a 12-month period. Implementation feasibility involved examining program adoption rates by sites and patients; acceptability, appropriateness, feasibility, and intent to sustain use survey scores; and pharmacists' interviews. Program effectiveness was based on patient referral rates, physician follow-up communication rates, and perceived outcomes, collected via patient logs, surveys, and interviews., Results: Two of the 15 sites discontinued participation, yielding an 87 % adoption rate. Patient adoption varied based on contact and screening rates, due to differences in patient recruitment, staffing, and workflow. Pharmacist acceptability, compatibility, and feasibility remained high throughout implementation; however, only three pharmacy sites planned on continuing offering the programs. All at-risk patients were appropriately referred based on screening results, with 65 % having their screening results communicated to their primary healthcare providers. The programs were perceived as beneficial, increasing pharmacists' knowledge and motivation, enhancing relationships with patients, and producing an impact on patients'' health., Discussion: Results highlight the implementation feasibility and preliminary outcomes of delivering DM and CVD S&R programs in community pharmacies. However, despite these positive results, most pharmacies did not intend to continue the programs, underscoring the continued need for sustainable clinical services models in non-traditional settings. Success with broader implementation will require a paradigm shift in support of community pharmacists as clinical care extenders., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Melanie Livet reports financial support was provided by the National Association of Chain Drug Stores (NACDS) Foundation. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Benzodiazepines and Z -drugs (e.g., zopiclone, zolpidem) (benzodiazepine receptor agonists or BZRAs), are prescribed for anxiety and insomnia disorders. However, they are not indicated as first line therapies for long-term management due to harms and efficacy limitations. BZRAs have also been associated with traffic accident risks. Patients taking BZRAs are told to consult with health care providers regarding motor vehicle operation safety. However, advice on driving is variable. The objective of this scoping review is to identify, map, and characterize the evidence for assessments that measure driving performance in people taking BZRAs., Methods: Embase (Elsevier), MEDLINE (Ovid), and PsycINFO (EBSCO) were searched. Covidence was used for screening. Each stage of screening included two independent reviewers. A REDCap database was used for data extraction by two independent reviewers. Results were tabulated and summarised as a narrative., Results: Driving performance was assessed with 20 unique BZRAs across 183 studies ( n  = 92 experimental; n  = 91 observational) in 178 publications. Zopiclone was the most studied. In experimental studies, the Standard Deviation of Lateral Position (SDLP) was used most often ( n  = 54, 62 %) and many studies ( n  = 35, 38 %) were conducted in the Netherlands. For observational studies, biological detection (e.g., urine, blood) ( n  = 73, 80 %) followed by prescription drug/dispensing records ( n  = 17, 19 %) were the most common impairment measures and Norway ( n  = 20) is where most studies took place. In experimental studies, most ( n  = 89, 97 %) were conducted using only one driving setting. Simulated driving in a car ( n  = 36) and road driving in traffic (n = 36) were common as compared to nontraffic driving course (n = 8) and simulated driving ( n  = 9). In experimental studies, seventy-eight of the 92 studies (85 %) had at least one measure that identified impairment., Conclusions: BZRA effects on motor vehicle driving performance have been studied using heterogenous protocols with multiple measures and settings, ranging from simulation to authentic traffic situations in experimental studies to biological detection and dispensing records in observational studies. Many BZRAs have been studied but study representation does not match prescribing pattern prevalence. The interpretation and contextualization of results for clinical practice is challenging due to the complexity (i.e., protocols, measures, settings). Future work in this area should work to improve knowledge translation of results so information is more readily accessible and applicable to health care providers and patients., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Antimicrobial resistance (AMR) is increasing globally and poses a significant public health challenge. Community pharmacists, especially in primary care settings, play a pivotal role in mitigating the irrational use of antibiotics, a key driver of AMR., Objectives: This study aims to explore qualitative insights from community pharmacists regarding antibiotic supply and usage, analyze sentiments related to AMR, and highlight the crucial role of community pharmacists in AMR stewardship at the primary care/community level., Methods: This study engaged community pharmacists in Thailand through semi-structured interviews to obtain in-depth insights into the antibiotic supply and perceptions of AMR. Additionally, sentiment analysis, which evaluates the emotional tone of the pharmacists' responses, was conducted to enrich the findings., Results: Interviews with 23 community pharmacists highlighted the practices, challenges, and strategies related to antibiotic supply and use. Key findings include the identification of barriers such as patient demand and lack of awareness about antimicrobial resistance (AMR), alongside strategies for improvement such as public education and professional development. Sentiment analysis reveals a cautiously optimistic perspective toward enhancing rational antibiotic use, underscoring the importance of comprehensive approaches that combine education, ethics, and regulatory measures to address the complexities of antibiotic management at community pharmacies., Conclusion: This study underscores the necessity of public awareness, pharmacist-patient relationships, and regulatory reforms for the rational use of antibiotics in community pharmacies. These findings emphasize that pharmacist education and adherence to professional ethics are essential for mitigating antimicrobial resistance and promoting rational antibiotic use., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The author is an Editorial Board Member/Editor-in-Chief/Associate Editor/Guest Editor for [Exploratory research in clinical and social pharmacy] and was not involved in the editorial review or the decision to publish this article., (© 2024 The Authors.)

Background: Professional pharmacy services are widely recognized for their role in promoting patient health and ensuring optimal medication therapy outcomes. Community pharmacies and pharmacists need to assess professional services' performance at patient level and demonstrate their value to stakeholders. To do so is important to understand which outcome performance indicators are currently being used and how added value is proven., Objective: To identify performance indicators that measure patients' outcomes and demonstrate value of professional pharmacy services., Methods: A narrative review was performed based on a systematic search in Pubmed and Scopus databases since year 2000. Manually search was also conducted in Google Scholar and Google.com. Inclusion criteria followed the PCC mnemonic in which Population is "community pharmacies", Context is "pharmaceutical care, professional pharmaceutical services or pharmaceutical interventions" and Concept is "key performance indicators, or performance measures or clinical indicators". English, Spanish or Portuguese language were accepted., Results: All types of papers were included, adding up to a total of 12 papers. The publication of papers on this subject has increased in the last decade. Outcomes indicators identified were based in different frameworks, mainly linked to quality, and were clearly outlined. Disease and therapy management were the most evaluated services. Indicators were identified across 8 different domains corresponding, predominantly, to outputs rather than outcomes. Measurement is mainly conducted under the auspices of coalitions, alliances, government and payers reflecting their perspectives and based on easy-to-retrieve pharmacy data and information., Conclusions: A paradigm shift is needed, so that performance indicators are based on more appropriate frameworks to measure patient level outcomes and value assignment of professional pharmacy services. By providing robust evidence of the impact of pharmacist interventions on patient outcomes, community pharmacists can advocate for the integration, expansion, and recognition of pharmacist-led services within the broader healthcare system., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The author is an Editorial Board Member/Editor-in-Chief/Associate Editor/Guest Editor for [Research in Social and Administrative Pharmacy] and was not involved in the editorial review or the decision to publish this article., (© 2024 The Authors. Published by Elsevier Inc.)

Background: Adolescent use of e-cigarettes has been recognized as a significant public health concern as rates of adolescent vaping increase. As evidence of respiratory damage and other health concerns continue to emerge, educational resources for parents are critical in combating the vaping epidemic. A vaping educational tool can serve as a resource that parents of adolescents can reference to learn about e-cigarette use and how to address this topic with their families., Objective: The purpose of this study was to examine parents' perspectives on the design and use of an educational infographic (Parent E -Cigarette and Vaping Educational Resource; P-EVER) to inform parents of adolescents and their families about e-cigarette use, risks, and quitting resources., Methods: Parents who had an adolescent aged 12 to 18 years were recruited through community pharmacies in Wisconsin through recruitment fliers, emails, and word of mouth between February and June 2023. Participants reviewed the vaping educational handout in a semi-structured interview that was recorded and transcribed verbatim. Two members of the research team independently coded each transcript using NVivo software to conduct inductive thematic analysis. Bi-weekly meetings were held to refine codes, develop the master codebook, and identify prevalent themes (intercoder reliability - 0.83)., Results: Thirty-five parents were interviewed between February and June 2023. Four themes were identified: vaping awareness, P-EVER content and implementation, pharmacist's role, and barriers to pharmacist intervention on vaping. Participants believed the vaping educational handout was an effective resource for disseminating information to parents of adolescents. Responses highlighted the importance of providing educational resources to initiate conversations surrounding health risks to adolescents., Conclusion: Pharmacists played a crucial role in successfully disseminating the P-EVER education tool to parents of adolescents. Future work is required to determine effective interventions for pharmacists and adolescents to discuss the topic of vaping awareness and safety., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Controlled substances (CS) are 'diverted' (stolen) from healthcare facilities via many integrated and diverse mechanisms due to a lack of safeguards. There remains a gap in understanding how healthcare workers (HCWs) leverage their social networks (e.g., their role/tasks and interactions with other roles/tasks) within the medication use process (MUP) that contribute to diversion. Social network analysis (SNA) is an analytic approach used to map and analyze social connections, which can help identify influential interdependence between HCWs and tasks susceptible to drug diversion., Objectives: To map the social network structures of MUP tasks vulnerable to CS diversion in two Inpatient pharmacies and compare diversion risks by identifying influential tasks and HCWs., Methods: This was an exploratory sequential mixed methods study conducted in the Inpatient pharmacies at two large hospitals in Toronto, Canada. Initial analysis used previously collected clinical observation data to identify key pharmacy roles and tasks vulnerable to CS diversion. Subsequently, a cross-sectional survey was conducted to collect demographic information on HCWs and assess their engagement in the identified vulnerable tasks. Clinical observations and survey data were used to perform two-mode SNA to identify connections between HCWs and tasks susceptible to drug diversion., Results: The analysis identified different network structures across both sites but highlighted the importance of strategic Pharmacist or Technician Supervisor oversight to moderate-high vulnerability tasks. Pharmacy technicians were found to be the network's most central actors, while Pharmacists had a more supportive role on the network's periphery, providing oversight. Across both sites, there was strong connectivity between HCWs and tasks, indicating a higher level of security against potential undetected diversion., Conclusion: By strategically involving Pharmacists or Technician Supervisors, diversion risk can be mitigated through cross-checking and quality control. Through identifying the network structure of each unit, hospitals can identify opportunities for future interventions to prevent diversion., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Pharmaceutical Care is a professional practice in high demand for implementation in Primary Health Care within the Public Health System. Consequently, it was necessary to develop and validate an instrument to assess the obstacles to this process., Methods: A methodological study was conducted in three stages: first, the questionnaire was developed based on the APOTECA framework, which includes Attitudinal, Political, Technical, and Administrative domains. Second, the content was validated using the Delphi Technique, with a content validity coefficient greater than or equal to 0.8 considered acceptable. Third, a pre-test was conducted with pharmacists working in Primary Health Care within the Public Health System. After validation, the instrument was administered to pharmacists participating in a training and support project for the implementation of Pharmaceutical Care., Results: The results indicated that the instrument was validated after two rounds of evaluation, with the first round involving 33 experts achieving a total content validity coefficient of 96 %, and the second round involving 18 experts achieving a total content validity coefficient of 98 %. In the third stage, the pre-test with Primary Health Care pharmacists resulted in a total content validity coefficient of 91 %. The final version of the questionnaire, which incorporated suggestions for improvements, included 19 questions. When answered by pharmacists, the responses indicated that Technical questions were the most significant barrier to implementation, followed by Political, Attitudinal, and Administrative questions., Conclusion: The validation of this instrument provides an important tool for identifying factors that hinder the implementation of Pharmaceutical Care within the Public Health System., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s). Published by Elsevier Inc.)

Background: Inpatients are at higher risk of Drug Therapy Related Problems (DTRPs), and early identification and management of these DTRPs is crucial for optimal treatment outcomes and ensuring rational drug therapy., Objective: This study aims to assess DTRPs in a general medicine ward of a tertiary care hospital in eastern Nepal., Methods: A three-month prospective observational study was conducted on inpatients admitted to the general medicine ward of the hospital. Pharmacists routinely performed patient drug therapy reviews, by which suspected DTRPs were identified and recorded as per the Pharmaceutical Care Network Europe Association (PCNE) v.9.1 guidelines. Binary logistic regression analysis was used to determine the influence of predictor variables on the occurrence of DTRPs., Results: A total of 301 inpatients were enrolled, out of which 233 (77.4%) had one or more DTRPs. Altogether, 528 DTRPs with an average of 2.27 ± 0.92 DTRPs per patient were identified. The primary causes of the DTRPs were drug selection (40.47%), treatment duration (16.71%), dispensing (15.75%), and dose selection (13.12%). Antimicrobials were involved in 55.18% of the DTRPs. DTRPs were more prevalent in elderly, comorbid patients, patients with longer hospital stay days, and polypharmacy, which was statistically significant (p<0.05). Furthermore, multivariate binary logistic regression analysis showed that geriatric patients had a higher risk of experiencing DTRPs, with an adjusted odds ratio of 1.832 (1.021-3.286) at p-value < 0.05., Conclusion: DTRPs are frequently prevalent in hospital wards, emphasizing the crucial role of clinical pharmacists in identifying, resolving, and preventing DTRPs in inpatient settings for optimal treatment outcomes., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: As of October 2024, 29 states and the District of Columbia allow community pharmacists to prescribe hormonal contraceptives. Pharmacists have reported many challenges and barriers to service implementation., Methods: Concept mapping was used to gather insights from diverse stakeholders to identify resources to facilitate implementation of pharmacist-prescribed contraceptive services. Stakeholders included end-users (pharmacy managers, staff pharmacists) and decision-makers (pharmacy owners/executives). Participants' ideas for resources were collected via multi-stakeholder focus groups. Participants then rated each idea (i.e. statement) in terms of importance and feasibility (1 = not at all important/feasible, 4 = extremely important/feasible) and sorted ideas into groups based on similarity via an online survey. Sorting data were analyzed using multidimensional scaling and hierarchical cluster analysis to develop a cluster map. Descriptive statistics were used to analyze rating data to develop a go-zone map, where statements rated above average in terms of both importance and feasibility are plotted in the "go-zone" and are considered the most actionable ideas., Results: Participants (focus groups n  = 19, survey n  = 48) generated 46 unique statements which created four clusters via multidimensional scaling: 1) implementation guidance for practice setup, 2) marketing resources, 3) billing and payment resources, and 4) appointment management. The majority of the statements (13 of 15) considered the most actionable were from the implementation guidance and appointment management clusters., Conclusions: Stakeholders seek guidance on implementation, marketing, billing and payment, and appointment management. To increase the ability of community pharmacies to meet the contraceptive needs of patients, resources should be dedicated to creating tools and solutions to address these identified needs., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Sally Rafie reports a relationship with Afaxys Inc. that includes: board membership and consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Ashley Meredith reports financial support was provided by Centers for Disease Control and Prevention. Ashley Meredith reports a relationship with American College of Clinical Pharmacy that includes: consulting or advisory and speaking and lecture fees. Ashley Meredith reports a relationship with Indiana Department of Health that includes: funding grants. Ashley Meredith reports a relationship with Pharmacy Times Office of Continuing Professional Education LLC that includes: speaking and lecture fees. Ashley Meredith reports a relationship with Hamad Medical Corporation that includes: travel reimbursement. Birth Control Pharmacist - advisory board member (Ashley Meredith) If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Inc.)

Background: Credentialing of advanced and specialist pharmacist practice (ASPP) provides essential quality assurance for ASPP, which is significantly different to entry-level practice and is developing worldwide. Several credentialing models are in place or under development internationally. Synthesis of the views and experiences of pharmacists and other relevant stakeholders on credentialing is an important research gap., Objectives: To determine pharmacy stakeholders' views and experiences of ASPP credentialing and to explore facilitators and barriers to credentialing implementation and uptake., Methods: The Joanna Briggs Institute convergent integrated approach for mixed methods systematic reviews was followed. The review protocol was pre-registered with PROSPERO. Five electronic databases (Medline, CINAHL, Embase, Web of Science, Google Scholar) were searched from inception to August 2022 for qualitative, quantitative, or mixed methods studies that reported the views and experiences of pharmacy stakeholders on ASPP credentialing. The Mixed Methods Appraisal Tool was used to quality appraise included studies. Thematic synthesis was undertaken to analyse and integrate data from included studies. All screening and data analysis steps were performed by two reviewers independently, with additional author input where required., Results: Sixty studies were included, after screening titles and abstracts ( n  = 9055) and full texts ( n  = 228). Studies represented the views of pharmacists, pharmacy managers/employers and professional/representative bodies in hospital, community pharmacy, general practice/primary care, and academic sectors, from 40 countries. Four analytical themes were generated describing the factors, including facilitators and barriers, to be considered when developing or optimising ASPP credentialing: I. Drivers of credentialing, II. Developing ASPP competence, III. Optimising credentialing implementation, and IV. Enhancing credentialing uptake., Conclusions: This systematic review is the first to synthesise pharmacy stakeholders' views and experiences of ASPP credentialing. A conceptual framework highlights contextual factors, facilitators, barriers, and inter-relationships which should be considered by pharmacists, policymakers, and other key stakeholders when implementing ASPP credentialing., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Published by Elsevier Inc.)

Contemporary patient care requires a multidisciplinary approach to monitoring, assessing, and managing diseases. Promoting multidisciplinary approaches encourages the purposeful participation of many healthcare professionals and harnessing their combined knowledge to provide tailored treatment plans. Pharmacists, skilled and knowledgeable professionals in medication management, drug-related problems, and disease prevention, can offer vital interventions that contribute to improved patient outcomes. Advances in healthcare and information technology have expanded pharmacists' professional roles and made them essential in healthcare. Pharmacist-managed clinics (PMCs), an innovative healthcare approach, could potentially improve patient safety, satisfaction, accessibility, and affordability to quality healthcare. Spread across the healthcare continuum, pharmacists have a well-defined role in providing comprehensive pharmaceutical care and interprofessional collaboration, further reinforcing the necessity of establishing PMCs. This narrative review aims to compile and summarize information on PMCs from PubMed, Scopus, Web of Science, and Google Scholar till December 2023. The PMC shortlist covers specialties such as cardiovascular, hematologic, endocrine, pain medicine, respiratory medicine, infectious diseases, gastrointestinal, nephrology, neurology, and oncology. Pharmacists in disease-specific PMCs have demonstrated improved treatment outcomes and access to specialty care. Additionally, based on peer-reviewed literature, the review also highlights how PMCs enhance the pharmacist's role in improving disease-specific outcomes, overall quality of care, and medication management. The inclusion criteria are randomized controlled trials, case-control studies, cohort studies, and pre-post studies involving patients from cardiology, hematology, endocrinology, pain medicine, respiratory medicine, infectious diseases, neurology, nephrology, gastroenterology, and oncology specialties, focusing on pharmacist-driven clinics, published in English, and covering any geographical location. The exclusion criteria include review articles, proposed models, commentaries, editorials, and those published in languages other than English. Our findings reveal that PMCs are underutilized globally. PMCs work better in developed countries, possibly on account of robust healthcare infrastructure, adequate healthcare budgets, availability of trained pharmacists, and supportive regulatory environments. The review found that pharmacist-led interventions, such as medication monitoring and patient education, significantly enhance therapeutic outcomes. Pharmacist Managed Clinics improve affordability and acceptability, expanding healthcare access in outpatient and inpatient settings. This review also highlights the critical need for implementing PMCs to improve healthcare delivery, particularly in providing comprehensive and accessible services in developing countries., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: There is a need to explore pharmacological options for syndrome (FMS), such as medical cannabis. The aim of this systematic review was to synthesize and analyze the available information about the effectiveness/efficacy and safety of cannabis-based products for medical use (CBPMs) and cannabis-based medicines (CBMs), in patients with FMS., Methods: Interventional or observational studies, systematic reviews and meta-analysis regarding the effectiveness/efficacy and safety of CBPMs and CBMs in patients with FMS were retrieved from the PubMed/Medline database until April 2024. Then, the information was summarized in tables, with the type of CBPM and CBM, the method used in the study and the effective-ness/efficacy and safety outcomes., Results: 19 publications were selected from the search or form the relevant references. Different CBPM and CBM were used across the studies. Also, different instruments for measuring the effectiveness were used. In general, the use of CBPMs and CBM showed an important improvement in pain, quality of life, and sleep habits. There were no serious adverse events., Conclusions: The results show that CBMPs and CBMs could be effective and safe in patients with FMS; however, the evidence is limited and there is a need for high-quality clinical studies conducted with improved methodological design., Competing Interests: Juan-Carlos Restrepo is chief officer scientific of “El dorado botanical” If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: The Medication-Related Burden Quality of Life (MRB-QoL) is a 31-item valid and reliable patient-reported measure of medicine burden on functioning and well-being in people with long-term conditions (LTC)., Objectives: To translate, culturally adapt, and content validate the MRB-QoL into Arabic., Methods: A rigorous approach to cross-cultural adaptation proposed by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guideline was followed. After 3 forward translations and 2 backward translations, a multidisciplinary expert panel assessed the content validity (CV) of the items through a 2-round e-modified Delphi method followed by two-step cognitive debriefings with patients with LTC using think-aloud and probing techniques. An item-content validity index (I-CVI) score of ≥0.78 was considered acceptable. The original questionnaire developers and other researchers, as members of the review committee, reviewed and approved the Arabic version., Results: Five semantic and 3 cultural translation discrepancies were identified and resolved by rewording the items. The 2 backward translations did not reveal significant problems, and equivalence to the original tool was confirmed following committee review. The Arabic version showed acceptable CV parameters. E -modified Delphi involved 9 experts in round one and 7 in round 2. The I-CVI scores ranged from 0.67 to 1.0, and agreement was reached after 2 rounds. The CVI for the final version of the MRB-QoL was 0.96. Expert panel review showed that the MRB-QoL-Arabic version is relevant (CVI = 0.92), important (CVI = 0.97), clear (CVI = 0.98), and comprehensive in measuring the burden of medicines. Data from 5 cognitive interviews showed that items and concepts included in the Arabic version of the MRB-QoL are relevant to the targeted sample, clear, and easy to understand., Conclusion: The MRB-QoL Arabic version was developed and content validated. However, further evaluation of its other psychometric properties is necessary before it can be utilized in clinical and research settings. Using this tool will enable a more accurate understanding of the effects of treatment burden on patient well-being, thereby guiding care toward minimally disruptive medicine., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Authors [MAM] and [TFC] are developers of the original MRB-QoL. Potential conflicts of interest may exist due to their role in its development. The remaining authors [SQA], [JH], and [HA] declare no conflict of interest. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Inc.)

Mpox, a zoonotic disease re-emerging from animals to humans, poses a risk of evolving into a global pandemic due to its high infectivity and potential asymptomatic transmission. This study maps the structure and configuration of mpox-related discussions on Twitter/X, identifies key influencers and top hashtags, and analyzes public sentiment. Data were collected using NodeXL Pro from May 7, 2022, to January 15, 2023, with the keyword "Monkeypox" and visualized using Gephi. Social network analysis ranked nodes by betweenness centrality scores to highlight key communicators, and the YifanHu layout algorithm visualized the network. Influential users, source topics, and hashtags were identified, and sentiment analysis was conducted using Azure Machine Learning tools. The analysis identified 11,397 mpox-related tweets. The network structure resembled a community with diverse participants. Influential users included health and science journalists, writers, academics, medical doctors, and public figures. News media and organizational websites were the top information sources, emphasizing the need for accessible scientific information. "Monkeypox" and "Mpox" were the most prevalent hashtags. Negative sentiments dominated the discussion. This analysis provides insights into network structure, key influencers, information sources, and public sentiment, aiding tailored health initiatives to address misinformation and advocate valid health information and emergency responses., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work rep that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported orted in this paper., (© 2024 The Authors.)

Background: The implementation of telepharmacy technology has expanded significantly, particularly during the COVID-19 pandemic, to ensure continuous pharmaceutical care services. This practice is vital in rural and underserved areas where access to healthcare is limited., Objective: This study aims to assess the knowledge, perception, and readiness of young pharmacists in rural Indonesia towards telepharmacy-assisted pharmaceutical services., Methods: A cross-sectional study was conducted from January to July 2023 in rural areas of Java, Sumatra, and Kalimantan, Indonesia. A convenience sampling method was employed with the aim of recruiting 520 registered pharmacists under 35 years of age (23-34 years old). Data were collected using an online questionnaire adapted for the local context and analyzed using SPSS version 26.0., Results: The study achieved an 86.67 % response rate. Most participants were female (73.1 %) and aged between 26 and 30 years (53.8 %). Nearly all pharmacists (97.1 %) held a Pharm.D degree. The knowledge assessment showed high awareness of telepharmacy's importance and its role during the COVID-19 pandemic, with 96.15 % recognizing the need for a strong internet connection. Positive perception was noted, with 90.38 % agreeing that telepharmacy enhances medication access in rural areas. However, concerns about increased error rates and workload were highlighted. A substantial proportion of pharmacists expressed readiness for conducting drug counselling via video consultation (44.23 %) and showed a willingness to undergo relevant training (59.62 %)., Conclusion: Young pharmacists in rural Indonesia demonstrate a good level of knowledge and generally positive perceptions about telepharmacy, with notable readiness among pharmacists with less than five years of experience. While there is notable willingness to engage in telepharmacy practices and training, addressing concerns about workload and data security through targeted support and training will be crucial for the successful implementation of telepharmacy, potentially enhancing healthcare access in rural areas., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author.)

Background: The COVID-19 outbreak had significant global healthcare implications, including the use of medications. This is specifically evident in the surge in use of some medication and a decline in the use of others. As a result, some medications end up unused, which may have subsequent health, economic, and environmental impacts., Aim: To explore patients' insights into unused medications during the COVID-19 outbreak., Materials and Methods: Semi-structured interviews were conducted with 30 patients attending various public and private healthcare facilities in Qatar between January and July 2021. A thematic analysis approach was utilized, with 2 researchers independently analyzing, comparing, and discussing the coding. The resulting themes were further discussed in research group meetings until a consensus was reached., Results: Seven themes emerged: awareness of unused medications and their impacts on health, economy, and the environment; barriers contributing to nonadherence/unused medications; sources of medications; factors facilitating medication use; patients' behaviors toward donated medications/reuse; patients' awareness of medication storage requirements; and patients' desire to appropriately dispose of unused medications., Conclusion: The COVID-19 outbreak disrupted medication supply and adherence, resulting in an increase in unused medications and inappropriate disposal. Adherence is crucial for improving patients' health and preserving medications. Implementing mail-return systems for unused medications could be a viable solution during disease outbreaks., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Published by Elsevier Inc.)

Background: With the national increase in the number of colleges and schools of pharmacy as well as the decreased pharmacy school applicant pool in recent years, pharmacy school enrollment challenges are at the forefront of issues facing pharmacy programs today. Factors that can influence a candidate's likelihood to pursue pharmacy school are important to evaluate. Recent studies assessing factors that motivate potential pre-health candidates to pursue pharmacy school or other healthcare careers are limited., Objective: To describe prospective candidates' perspectives and attitudes toward pharmacy as a career pathway and assess factors that motivate or deter them from pursuing pharmacy as a career and from considering a specific pharmacy school., Method: The study was cross-sectional and used an online data collection form distributed via the Qualtrics platform from October 4, 2022 through October 12, 2022 using the social media platform Reddit. Reddit has hundreds of subcommunities known as subreddits, that allow for exchange of ideas and discussion regarding various topics. This social media platform is commonly used by pre-health students to discuss career options. The survey consisted of 28 items and two domains, demographics and prospective healthcare students' understanding of responsibilities of pharmacists and their overall perspective on pharmacy as a profession. The survey was targeted toward anyone with an intention of pursuing a health science degree or career., Result: Four hundred participants completed the survey. Participants were mainly Caucasian, male, and with a mean age of 25 years. This study assessed prospective candidates' perspectives and attitudes toward pharmacy as a career pathway, appealing and unappealing characteristics about pursuing a career in the field of pharmacy, and factors that motivate or deter candidates from pursuing pharmacy. While 68 % of the participants had heard that career choices are vast and vary in the field of pharmacy, most still had concerns about the pharmacy field being heavily saturated and lack of job opportunities after graduation. Almost 60 % of responders gained information about pharmacy programs through social media platforms. The North American Pharmacist Licensure Examination pass rate, postgraduate residencies/fellowships, program duration and program reputation were among the top factors in choosing a pharmacy program., Conclusion: Many survey participants had heard that there are a variety of job opportunities in the field of pharmacy, but the majority had heard that the pharmacy field is heavily saturated and that there are lack of opportunities after graduation. Most responders gained information through social media platforms. For prospective pharmacy school candidates, NAPLEX pass rate, number of graduates matched with PGY1 residencies and fellowships, and duration and reputation of the program seems to be among the most important factors in choosing a pharmacy program. Factors that prospective candidates consider when selecting a pharmacy program and the means they use to research about programs can be important considerations for pharmacy programs recruitment. Awareness of the preferences and baseline knowledge of candidates about the field of pharmacy can aid in developing targeted recruitment strategies and informing decision-making in pharmacy programs and recruitment efforts., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Human Normal Immunoglobulin (HNIg) is a complex plasma-derived blood product used to treat a variety of medical conditions. Global supply problems have increased focus on HNIg stewardship, including mandatory recording of HNIg usage on the National Immunoglobulin Database (NIgD). Local departmental audits identified significant inconsistencies in data uploaded to NIgD. Inventory management issues caused a number of stock losses in the last financial year. A paper-based HNIg batch number recording system was replaced with the use of Automated Dispensing Cabinets (ADCs), which generated an electronic batch number report, with matching fields required for electronic upload to NIgD., Aim: To measure the impact of ADC implementation on the accuracy of data uploaded to NIgD, HNIg stock control and staff time associated with processes of HNIg data and inventory management., Method: Three months of pre- and post-implementation HNIg dispensing data was compared to the data uploaded to the NIgD for discrepancies. Inventory reports were used to identify unexplained stock adjustments. Time and motion methods were used to quantify staff time associated with HNIg activities., Results: Pre-implementation: 20.7 % (3762.5 g/18,217 g) of HNIg by volume (23.7 % of dispensing episodes; 66/279) were inaccurately uploaded or absent on the NIgD and three stock adjustments were made (loss of >£15 k). Post-implementation: 12 % (2325 g/19,347 g) of HNIg by volume (10.8 % of dispensing episodes; 31/286) were inaccurately uploaded or absent on the NIgD and zero stock adjustments were observed; Mean time for dispensing per HNIg prescription reduced from 17 min to 8 min; Time spent uploading data to NIgD per month reduced from 5 h to 1.75 h., Discussion/conclusion: The use of ADCs improved accuracy of NIgD data upload. Following implementation direct observations have cited unregistered or finished patient episodes, dispensing procedural compliance, and user familiarity with the system as common reasons for incomplete data uploads to NIgD. The new ADC process had consequences of forcing dispensing procedure compliance to improve uploads, whilst reducing dispensing times. It led to improved stock control and removed upload burden from dispensers. ADC stock discrepancy alerts allowed staff to proactively resolve discrepancies in real time. Time taken for additional processes to support management of stocks in ADCs, including monthly stock cycle counts, were important considerations for implementation. The key advantage of using ADC batch number reports is the ability to upload as a single monthly batch without having to manually access individual patient records on the NIgD. It facilitates early identification of failed upload attempts and supports resolution of stock discrepancies., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Inc.)

Background: Resilience is a complex concept that is defined and influenced by the context of individuals, organisations, societies and cultures. The Connor-Davidson Resilience Scale (CD-RISC) is a widely used validated tool to evaluate psychological resilience. CD-RISC is a self-administered scale of twenty-five items, each rated by a 5-point Likert scale. The scale evaluates overall personal resilience through assessing five main resilience-related constructs; personal competence, trust in one's instincts, positive acceptance of change, control and spiritual influences. As per the scale's developers, higher scores reflecting greater level of resilience. This particular tool has not previously been tested with a pharmacy student or academic population sample., Objective: This study aims to assess the factor structure, validity, and reliability of the CD-RISC-25 in a sample of pharmacy students and academics from faculties drawn across the Eastern Mediterranean Region (EMR)., Methods: A cross-sectional study was carried out between October 2020 and January 2021 sampling pharmacy students and academics across the EMR who were invited to complete the self-administered CD-RISC 25 questionnaire. Confirmatory factor analysis using principal components analysis with oblique rotation was conducted on sample responses ( n  = 616). The internal consistency and reliability for each identified factor and from the CD-RISC scale was evaluated by using Cronbach's alpha coefficient., Results: Five factors were isolated accounting for 51.5 % total cumulative model variance. Identification of factors showed high convergence with previous work on the CD-RISC resilience tool. The current study in our sample found a five-factor structure which differed from the original scale reliabilities. This study did identify a five-factor solution with differing item factor loadings. The reliability analysis on the CD-RISC-25 items in our study sample revealed an overall Cronbach Alpha value of 0.89; however, three items showed corrected Item-total correlations of <0.3. Our analysis, in this respondent sample, suggested a re-adjustment of the scale inclusions to improve overall scale stability and performance., Conclusions: The current research findings propose a modified five-factor structure to resilience, with a 22-item unidimensional model of CD-RISC scale., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: More than 50 % of cancer survivors experience late effects of cancer (LEC). Current models of follow-up care often prove inadequate, resulting in unresolved LEC. Given the pivotal role of community pharmacists as the most accessible healthcare professionals and the demonstrated benefits of evidence-based pharmacy services on patient centered care, exploring the potential contribution of community pharmacies in managing LEC is relevant., Objective: This study aimed to investigate cancer survivors' needs, preferences, and attitudes regarding pharmacy involvement in managing LEC., Method: The developed questionnaire based on validated instruments underwent a pilot test among cancer survivors at four Danish community pharmacies. In August 2021, the questionnaire was distributed to all 611 cancer survivors of the Danish Cancer Society's cancer patient panel. The resulting quantitative data were subjected to descriptive statistical analysis, while qualitative data underwent a thematic content analysis., Results: Among the 611 panel members, 354 responded to the questionnaire (response rate 58 %). Fatigue was the most frequent LEC experienced by 88 % of respondents. Three out of four (75 %) of respondents expressed dissatisfaction with the level of counseling they had received regarding LEC, and 23 % disclosed not having discussed LEC with a healthcare professional despite feeling the need to do so. Nearly all respondents visited pharmacies annually and used available products to alleviate LEC. Approximately half of respondents expressed a need for counseling on the appropriate use of these products. While nearly half of respondents were receptive to pharmacy-based counseling, concerns regarding discretion and staff knowledge were prevalent., Conclusion: Cancer survivors experience an insufficiency in counseling on LEC and demonstrate an openness towards involving community pharmacies in addressing this gap. However, further investigation is warranted to delineate survivors' specific needs and expectations regarding community pharmacy involvement in LEC management. Additionally, suggestions from survivors underscore the importance of enhancing pharmacy staff knowledge and establishing discreet counseling areas., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Inc.)

Objective: To identify and evaluate montelukast deprescribing in outpatient specialty clinics., Methods: This was a single-center, retrospective, cross-sectional study conducted at an academic health system in the southern US including 21 specialty clinics. Subjects included adults ≥18 years with an active prescription for montelukast who attended at least one appointment in pulmonology, otolaryngology, or neurology outpatient specialty clinics between January 1, 2021 to December 31, 2022. Patients <18 years and those with diagnoses of uncontrolled asthma or allergic rhinitis were excluded. Outcomes assessed included the frequency and period prevalence of montelukast deprescribing, defined by a documented montelukast discontinuation within the medical record, and evaluation of reasoning for discontinuation mentioned in visit notes., Results: There were 1152 patients who met inclusion criteria. Of these, 43 (3.7 %) experienced a montelukast deprescribing event: 18 (41.9 %) in neurology, 13 (30.2 %) in otolaryngology, and 12 (27.9 %) in pulmonology. Documented reasons for deprescribing were only available for 11 patients (25.6 %); reasons for deprescribing included patient-provider shared decision-making regarding the Black Box Warning [ n  = 5 (11.6 %)], inadequate treatment response [ n  = 3 (7.0 %)], suicidal thought development [ n  = 1 (2.3 %)], adverse drug event [ n  = 1 (2.3 %)], and pregnancy planning [ n  = 1 (2.3 %)]., Conclusion: Montelukast deprescribing rates were less than 5 % in outpatient specialty clinics. Factors associated with montelukast deprescribing beget further investigation., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Paul M Boylan reports a relationship with Pfizer Inc. that includes: funding grants. Paul M Boylan reports a relationship with Pharmacy Times Office of Continuing Professional Education LLC that includes: speaking and lecture fees. Grant H Skrepnek reports a relationship with Pfizer Inc. that includes: funding grants. Grant H Skrepnek reports a relationship with Otsuka America Pharmaceutical Inc. that includes: funding grants. Grant H Skrepnek reports a relationship with Janssen Scientific Affairs that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Appropriate dosing of direct oral anticoagulants (DOACs) has been associated with clinical efficacy and safety. Several studies have shown that DOAC dosing are often inconsistent with guideline recommendations. Little is known about this issue in Thailand. This study aimed to evaluate the appropriateness of DOAC dosing in Thai hospitalized patients with atrial fibrillation (AF)., Method: This was a retrospective descriptive study conducted on hospitalized patients at Rajavithi Hospital, a tertiary care hospital in Thailand. Inpatients diagnosed with AF and treated with DOACs between February 2021 and February 2023 were enrolled in the study. The appropriate dosing of DOACs was assessed according to the recommendation of the 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation (EHRA). Descriptive statistics were used to analyze the data; median (interquartile range) for continuous variables, and numbers and percentages for categorical variables., Results: A total of 120 patients with AF were evaluated for dosing. The patients received rivaroxaban in 47 cases (39.2 %), apixaban in 32 cases (26.7 %), edoxaban in 31 cases (25.8 %), and dabigatran in 10 cases (8.3 %). Most of the patients were elderly, with a median age of 77.5 (68-84) years. Females were predominant (57.5 %). Our findings indicate that the prevalence of appropriate dosing of DOACs was 63.3 %. However, approximately one-third of patients received inappropriate dosing, with 24 (20.0 %) being overdosed, and 20 (16.7 %) being underdosed. The highest overdosing and underdosing rates were seen in dabigatran (90.0 %) and apixaban (21.9 %), respectively., Conclusion: Inappropriate dosing of DOACs according to the 2021 EHRA recommendations was high in 36.7 %, with overdosing mostly occurring in 20.0 %. The high number of inappropriate dosing highlights the need for implementation of optimal strategies to select the appropriate dose of DOACs in Thai hospitalized patients with AF., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Medication history telepharmacy consults are conducted prior to patients commencing their systemic anti-cancer therapy. At the study institution, this has historically been carried out as an unscheduled telephone consult. However, due to challenges with telephone consults, a scheduled videoconsult model was established. Funding, time efficiency, and completion rate for videoconsults compared to telephone consults have been examined previously., Objective: The aim of this study was to determine staff perceptions of the factors that influence implementation, including enablers and barriers, for videoconsults compared to telephone consults, to inform model sustainability., Methods: Semi-structured interviews were conducted with staff ( n  = 14) involved with the videoconsult service, or who provided care for patients who had a videoconsult. Interviews were coded for positive or negative influence and strength using the Consolidated Framework for Implementation Research (CFIR) 2.0, to understand which constructs influence implementation., Results: Thirty-nine of the 79 constructs, from across four domains were identified as influences for the telephone and videoconsult models. Six constructs were strongly differentiating for videoconsults over telephone consults. Of the 25 positively influencing constructs for the videoconsult model, strongest ratings (+2) were given for innovation advantages, critical incidents, support persons assisting in the consult, financing related to funding reimbursement, and telehealth coordinator capability and motivation. Barriers unique to the videoconsult model included the many steps that were involved, compatibility with workflows, and pharmacist resource. Similarities and differences unique to each model were identified., Conclusion: Findings demonstrated a number of strongly differentiating constructs highlighting superiority of the videoconsult model. However, implementation of both models had multiple enablers and barriers that may influence adoption. The potential of a hybrid service, using both telephone consults and videoconsults, may help optimise delivery of services., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Inc.)

Objective: This study aims to understand customer perceptions of community pharmacies utilizing publicly available data from Google Maps platform., Materials and Methods: Python was used to scrape data with Google Maps APIs. As a result, 17,237 reviews were collected from 512 pharmacies distributed over Riyadh city, Saudi Arabia. Logistic regression was conducted to test the relationships between multiple variables and the given score. In addition, sentiment analysis using VADER (Valence Aware Dictionary for Sentiment Reasoning) model was conducted on written reviews, followed by cross-tabulation and chi-square tests., Results: The Logistic regression model implies that a unit increase in the Pharmacy score enhances the odds of attaining a higher score by approximately 3.734 times. The Mann-Whitney U test showed that a notable and statistically significant difference between "written reviews" and "unwritten reviews" (U = 39,928,072.5, p  < 0.001). The Pearson chi-square test generated a value of 2991.315 with 8 degrees of freedom, leading to a p value of 0.000., Discussion: Our study found that the willingness of reviewers to write reviews depends on their perception. This study provides a descriptive analysis of conducted sentiment analysis using VADAR. The chi-square test indicates a significant relationship between rating scores and review sentiments., Conclusion: This study offers valuable findings on customer perception of community pharmacies using a new source of data., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Low levels of knowledge among health professionals about autism spectrum disorders (ASD) can impair the care provided to people with autism. In Brazil, there are still no validated instruments that assess the knowledge of pharmacy students and pharmacists regarding ASD., Objective: This study aimed to carry out the cross-cultural adaptation of the Autism Stigma Knowledge Questionnaire (ASK-Q) into Brazilian Portuguese and to evaluate the evidence of content validity., Methods: This study was conducted in two stages, as recommended in the literature. Stage 1 corresponded to cross-cultural adaptation carried out in six phases (translation of the ASK-Q, synthesis of the translations, evaluation by a committee of experts, evaluation by the target audience of pharmacy students and pharmacists, reverse translation, and evaluation by the author of the original instrument). Step 2 corresponds to the assessment of content validity evidence., Results: The instrument presented semantic, idiomatic, conceptual, and cultural equivalences, and the author considered the adaptation adequate. Content validity had an adequate coefficient (0.89). The ASK-Q was cross-culturally adapted to the Brazilian context according to the main theoretical framework., Conclusions: Future studies will be conducted to evaluate other evidence for the validity of the ASK-Q-Brasil. These studies will be fundamental in assessing knowledge about ASD., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The author is an Editorial Board Member/Editor-in-Chief/Associate Editor/Guest Editor for [Journal name] and was not involved in the editorial review or the decision to publish this article., (© 2024 Published by Elsevier Inc.)

Professionalism represents the ethical contract that binds professionals and society. Its technical aspects, such as the professional practice model, form the foundation for attitudinal and behavioral characteristics, including the fiduciary relationship between pharmacists and patients. Despite significant interest in the topic, contextualizing professionalism proves to be a challenging endeavor, relying on collaboration among formal leaders, academics, and practitioners in the field. Consequently, defining, understanding, teaching, and evaluating pharmaceutical professionalism contribute to shape societal perceptions and the understanding of pharmacists and students, who may occasionally struggle to grasp the underlying rationale behind professional practices. Moreover, contextualizing professionalism entails addressing various challenges, such as fostering support for professionalism and its adaptation, which encompasses pharmacists' performance across diverse clinical services, their interpersonal interactions with patients, families, communities, and fellow healthcare professionals, as well as personal job satisfaction amidst obstacles as job insecurity, ethical dilemmas, and compromised autonomy., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs)-related morbidity and mortality can be reduced through medication counselling and risk reduction., Objectives: This study evaluated the impact of short online modular NSAID training on the type and quality of questions asked, risk factors assessed, and counselling offered by community pharmacists to NSAID users., Methods: A cross-sectional questionnaire-guided survey conducted in Ibadan, Nigeria, among 87 pharmacists evaluated the frequency of counselling, NSAID risk factor assessment and barriers to risk assessment. Additionally, a before-and-after RCT was used to evaluate the impact of short online modular NSAID training for the intervention group (IG) on the type and quality of the questions asked, counselling provided, and risk assessed by the pharmacists. Eight standardised patients, aged 25-43 years, four at pre- and postintervention, presented four standardised scenarios at community pharmacies [IG, n  = 22, control group (CG, n  = 30)] to assess these outcomes. The quality of each outcome (questions asked, counselling offered and risk assessed) was classified as poor (0-≤20%), fair (>20-≤40%), moderate (>40 - ≤60%), or optimal (>60-100%). The data are presented with descriptive statistics., Results: The community pharmacists reported counselling patients on NSAID precautions (80-86%) and dosages (51-69%). Gastrointestinal bleeding risk was assessed by 61-89% of the pharmacists, and time constraints (39-42%) and patient impatience (47-75%) were some barriers to risk assessment. Online modular educational intervention significantly improved the types and quality of questions asked by pharmacists (CG: poor to fair, 16%-21%; IG: poor to moderate, 14%-45%), NSAID risk factors assessed (CG: poor to poor, 10%-9%; IG: poor to fair, 11%-27%) and counselling offered (CG: poor to poor, 6%-7%; IG: poor to fair, 6%-22%)., Conclusions: Short online modular educational training on NSAIDs improved the types and quality of the questions asked, NSAID risk factors assessed, and counselling provided by community pharmacists to patients during consultations., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Medication review and reconciliation is essential for optimizing drug therapy and minimizing medication errors. Large language models (LLMs) have been recently shown to possess a lot of potential applications in healthcare field due to their abilities of deductive, abductive, and logical reasoning. The present study assessed the abilities of LLMs in medication review and medication reconciliation processes., Methods: Four LLMs were prompted with appropriate queries related to dosing regimen errors, drug-drug interactions, therapeutic drug monitoring, and genomics-based decision-making process. The veracity of the LLM outputs were verified from validated sources using pre-validated criteria (accuracy, relevancy, risk management, hallucination mitigation, and citations and guidelines). The impacts of the erroneous responses on the patients' safety were categorized either as major or minor., Results: In the assessment of four LLMs regarding dosing regimen errors, drug-drug interactions, and suggestions for dosing regimen adjustments based on therapeutic drug monitoring and genomics-based individualization of drug therapy, responses were generally consistent across prompts with no clear pattern in response quality among the LLMs. For identification of dosage regimen errors, ChatGPT performed well overall, except for the query related to simvastatin. In terms of potential drug-drug interactions, all LLMs recognized interactions with warfarin but missed the interaction between metoprolol and verapamil. Regarding dosage modifications based on therapeutic drug monitoring, Claude-Instant provided appropriate suggestions for two scenarios and nearly appropriate suggestions for the other two. Similarly, for genomics-based decision-making, Claude-Instant offered satisfactory responses for four scenarios, followed by Gemini for three. Notably, Gemini stood out by providing references to guidelines or citations even without prompting, demonstrating a commitment to accuracy and reliability in its responses. Minor impacts were noted in identifying appropriate dosing regimens and therapeutic drug monitoring, while major impacts were found in identifying drug interactions and making pharmacogenomic-based therapeutic decisions., Conclusion: Advanced LLMs hold significant promise in revolutionizing the medication review and reconciliation process in healthcare. Diverse impacts on patient safety were observed. Integrating and validating LLMs within electronic health records and prescription systems is essential to harness their full potential and enhance patient safety and care quality., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Background: Access to healthcare services is a major barrier to residents of the rural state of South Dakota. As a highly accessible member of the healthcare team, outpatient pharmacists can play a key role in a patient's healthcare journey. There is a need to identify the unique barriers and facilitators pharmacists in both rural and urban areas face to maximize the impact of their role., Objective: The objective of this work was to compare perceptions of rural and urban pharmacists regarding the facilitators and barriers to providing patient care in South Dakota., Methods: This qualitative project highlights results from interviews and focus group sessions with a convenience sample of South Dakota pharmacists. Participants were recruited using a referral word-of-mouth system, contracts with healthcare market research agencies, newspaper advertisements, and posters displayed in public locations in South Dakota. Practice location was characterized as rural or urban based on United States Department of Agriculture definitions. Findings from interviews and focus group sessions were coded and analyzed using content analysis by two student researchers., Results: Participants included 12 rural-practicing and 21 urban-practicing pharmacists in South Dakota. In both rural and urban areas, key barriers included communication with providers (50% rural; 50% urban), lack of electronic health record access (25% rural; 14% urban), not enough staff (22% rural; 20% urban), and patient misunderstanding the scope of pharmacy (22% rural; 40% urban). Barriers specific to rural areas included time to provide services (22%), having smaller facilities (27%) and provider hesitation regarding collaborative practice agreements (29%). There were no urban-specific barriers. Facilitators specific to urban areas included frequent communication with patients (6.1%) and good quality support staff (9.1%). There were no rural-specific facilitators., Conclusions: Next steps include increasing awareness of pharmacy-based patient care services, researching further to identify the extent to which facilitators and barriers influence the ability to initiate and sustain pharmacy services in rural and urban areas, and providing support to pharmacies to overcome barriers and leverage facilitators., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Inc.)

Background: Effective treatment of osteoporosis is hindered by poor adherence and lack of persistence with medical therapy. Interventions can be designed to elicit and address patients' concerns about side effects and promote self-management. Objective(s): The aim was to develop and evaluate the impact of a community pharmacy-based medication management intervention on patients' adherence to osteoporosis medicines using both objective and subjective measures of adherence. Secondary aims were to report the proportion of patients that had been referred to their General Practitioner (GP) for assistance with osteoporosis management, and to measure patients' experiences with the service. Methods: This study used a cohort design. Community pharmacy dispensing data were obtained as an objective measure of adherence. Self-reported beliefs about medicines (Beliefs about Medicines Questionnaire) and self-reported adherence (Medication Adherence Reporting Scale 5) were also collected. Data were collected and compared between baseline, 4 weeks after intervention, and endpoint (approximately a year after intervention). Analysis of correlations between measures was also conducted. GP referral percentage and perceived service quality scale (pSQS-SF6) was obtained. Results: Pharmacists and support staff from 26 Australian community pharmacies were recruited and trained to implement the service, and 107 patients were recruited. Of these, 71 were available for follow-up interviews by research team at 4 weeks, and 54 at the endpoint. No changes were found in pre-post analysis for the objective or self-reported measures of adherence. Patients' concerns about osteoporosis medicines were lower at 4 weeks and at the study endpoint compared to baseline. Uptake of pharmacists' referrals to patients' GPs was 48.1% by 4 weeks. Patient experience was rated highly (median pSQS-SF6 = 6.5/7). Conclusions: This study demonstrates the potential of community pharmacy interventions designed to optimize medication adherence by eliciting patients' thoughts and feelings about using osteoporosis medicines and addressing them using motivational interview techniques., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Introduction: Community pharmacies, as unique and accessible healthcare venues, are ideal locations to implement interventions aiming to improve patient care. However, these interventions may increase workload or disrupt workflow for community pharmacists, technicians, and other staff members, threatening long-term sustainment. There are growing calls from the field of implementation science to design for intervention sustainment and maintenance by maximizing innovation fit. Senior Safe™, an intervention to facilitate safer over-the-counter (OTC) product selection by older adults, serves as a case study to examine the congruence between Innovation Factors and community pharmacy Inner Context constructs and their implications for workload and sustainment., Methods: Using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, this qualitative study identified factors surrounding Senior Safe implementation. Semi-structured interviews were conducted with staff from pharmacies where Senior Safe was implemented. Two coders independently analyzed interview transcripts using deductive analysis based on EPIS constructs. Thematic analysis was used to generate three themes that encapsulated innovation fit., Results: Nineteen pharmacy staff members participated, with the majority reporting no significant change in their workload or workflow due to Senior Safe. Interview feedback supported a pre-existing culture of the healthcare system to engage patients, of leadership commitment to patient safety initiatives, and of an amplified role of pharmacy technicians., Discussion and Conclusion: Pharmacy staff interviews revealed congruence between Innovation Factors and Inner Context that likely yielded intervention workload neutrality. This study highlighted the importance for researchers to consider maintenance and sustainability when designing and implementing an intervention and the critical influence of culture and leadership support during this process., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Self-medication among university students is becoming a health concern, especially during examinations and stress. This pattern of medication use among students could lead to adverse health consequences if it is not addressed and tackled. Thus, this study investigated the most associated factors with this practice among students., Methods: An observational cross-sectional study was conducted among university students in Northern Borders Province, Saudi Arabia. A total of 220 students were selected and took part in the survey. Data was collected through a self-administered questionnaire. The survey was distributed among participants to answer five sections: demographic and socioeconomic characteristics, health status problems, satisfaction with academic performance, and self-medication questions. The content validity was tested using a pilot sample of 30 students. The descriptive, univariate, and multivariate analyses were conducted using the Statistical Package for Social Science program., Results: In the present sample of university students, the response rate was 100%. Approximately one-third reported using medications without prescriptions, and 83% of them have used medications three times at most during the past 12 months. Headache was the most common reason for use (59%), followed by fever (20%). Adjusted multivariate analysis showed that students who were 21-24 years of age (OR = 3.79, 95% CI = 1.21-11.82), female (OR = 2.43, 95% CI = 1.03-5.72), and living alone in private housing (OR = 3.62, 95% CI = 1.32-9.90) were at high risk of self-medication as compared to their counterparts. However, students in the last years of college (fourth (OR = 0.14, 95% CI = 0.03-0.62), fifth (OR = 0.21, 95% CI = 0.05-0.95), sixth (OR = 0.05, 95% CI = 0.01-0.35)) were at lower risk as compared to their counterparts., Conclusion: The study found that self-medication was common among university students, with higher rates among those who were 21-24 years old, female, and living alone in private housing, but lower rates among students in the later years of college. Educational programs and awareness campaigns should target students who are at higher risk of practicing self-medication to avoid misuse of over-the-counter medications., Competing Interests: “The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.”, (© 2024 The Authors. Published by Elsevier Inc.)

Background: In the U.S. alone, medication non-adherence is estimated to cause 1 in 10 hospitalizations, approximately 125,000 deaths annually, and cost the U.S. healthcare system just under $300 billion each year. Patients in medically underserved areas (MUAs) are particularly vulnerable to all forms of non-adherence and downstream morbidity and mortality; however, the extent to which primary medication non-adherence (i.e., prescription abandonment) affects the underserved is still largely unknown., Objectives: To assess the difference in rates of abandonment of quality measured prescriptions in areas that are medically underserved compared to areas that are not. The secondary objective is to assess the impact that the COVID-19 pandemic had on rates of prescription abandonment in both MUAs and those that are not., Methods: In this retrospective study, data on abandoned, quality measured prescriptions were collected and analyzed using Chi-Square analyses from one regional division of a large grocery-chain pharmacy containing ninety-one pharmacies located in Tennessee, Mississippi, Arkansas, Kentucky, and Missouri. The primary objective used 2019 data while the secondary objective used data from April - November of both 2019 and 2020., Results: Patients from MUAs abandoned quality measured prescriptions at a higher rate of 5.44% compared to 4.77% of those not living in these areas ( P  < 0.01). This study also discovered that during the COVID-19 pandemic, MUAs had a decrease in abandonment from 6.14% in 2019 to 6.02% in 2020 ( P  < 0.01). Those from non-MUAs had non-significant change in abandonment ( P  = 0.87)., Conclusion: Patients in MUAs abandon quality measured prescriptions at a statistically significant higher rate when compared to patients who live in areas that are not considered to be medically underserved. Moreover, during the COVID-19 pandemic patients living in MUAs had a statistically significant decrease in prescription abandonment while those in non-MUAs did not statistically change., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Introduction: Students in pharmacy are positive towards integrating artificial intelligence and ChatGPT into their practice. The aim of this study was to investigate the direct short-term learning effect of using Chat GPT by pharmacy students., Methods: This was an experimental randomized study. Students were allocated into two groups; the intervention group ( n  = 15) used all study tools and ChatGPT, while the control group ( n  = 16) used all study tools, except ChatGPT. Differences between groups was measured by how well they performed on a knowledge test before and after a short study period., Results: No significant difference was found between the intervention and control groups in level of competence in the pretest score ( p   =   0.28 ). There was also no significant effect of using ChatGPT, with a mean adjusted difference of 0.5 points on a 12-point scale. However there was a trend towards a higher proportion of ChatGPT participants having a large (at least four point) increase in score (4 out of 15) vs control group (1 out of 16)., Conclusion: There is a potential for positive effects of ChatGPT on learning outcomes in pharmacy students, however the current study was underpowered to measure a statistically significant effect of ChatGPT on short term learning., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Background: While suboptimal medication adherence remains an obstacle to the management of hypertension and diabetes in China, few studies have investigated associated factors with medication adherence on different dimensions simultaneously., Objective: To systematically examine associated patient, family, and community factors with suboptimal medication adherence among people with hypertension and/or type 2 diabetes in China., Methods: The study stratified a random sample of 622 adults aged 45 years or older with hypertension and/or type 2 diabetes from three southeast cities in China in 2019. Trained interviewers used the Morisky Green Levine Medication Adherence Scale, Self-Efficacy to Manage Chronic Disease (SEMCD) Scale, and the Family Adaptability, Partnership, Growth, Affection, and Resolve (APGAR) Scale to assess medication adherence, self-efficacy, and family function, respectively. Participants also reported their perceived satisfaction with community health services (quantity, quality, affordability, and overall acceptance). The study used the multivariable logistic regression to assess the association of patient, family, and community factors with suboptimal medication adherence., Results: Among the participants, 42.9% reported suboptimal medication adherence. In the multivariable logistic regression model, male participants (odds ratio [OR] = 0.55, p  = 0.001) had higher medication adherence compared to females. Having a self-efficacy score that was lower than or equal to the sample mean was significantly associated with lower adherence (OR = 1.44, p  = 0.039). Participants unsatisfied with the affordability of community health services and medicine had lower adherence (OR = 2.18, p =  0.028) than those neutral or satisfied. There were no significant associations between family function and medication adherence., Conclusions: Sex, self-efficacy, and perceived affordability of community health services were important factors associated with medication adherence. Healthcare professionals are recommended to consider multiple factors and leverage services and resources in community health centers when promoting medication adherence., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Introduction: Generative artificial intelligence (Gen-AI), exemplified by the widely adopted ChatGPT, has garnered significant attention in recent years. Its application spans various health education domains, including pharmacy, where its potential benefits and drawbacks have become increasingly apparent. Despite the growing adoption of Gen-AIsuch as ChatGPT in pharmacy education, there remains a critical need to assess and mitigate associated risks. This review exploresthe literature and potential strategies for mitigating risks associated with the integration of Gen-AI in pharmacy education., Aim: To conduct a scoping review to identify implications of Gen-AI in pharmacy education, identify its use and emerging evidence, with a particular focus on strategies which mitigate potential risks to academic integrity., Methods: A scoping review strategy was employed in accordance with the PRISMA-ScR guidelines. Databases searched includedPubMed, ERIC [Education Resources Information Center], Scopus and ProQuestfrom August 2023 to 20 February 2024 and included all relevant records from 1 January 2000 to 20 February 2024 relating specifically to LLM use within pharmacy education. A grey literature search was also conducted due to the emerging nature of this topic. Policies, procedures, and documents from institutions such as universities and colleges, including standards, guidelines, and policy documents, were hand searched and reviewed in their most updated form. These documents were not published in the scientific literature or indexed in academic search engines., Results: Articles ( n  = 12) were derived from the scientific data bases and Records ( n  = 9) derived from the grey literature. Potential use and benefits of Gen-AI within pharmacy education were identified in all included published articles however there was a paucity of published articles related the degree of consideration to the potential risks to academic integrity. Grey literature recordsheld the largest proportion of risk mitigation strategies largely focusing on increased academic and student education and training relating to the ethical use of Gen-AI as well considerations for redesigning of current assessments likely to be a risk for Gen-AI use to academic integrity., Conclusion: Drawing upon existing literature, this review highlights the importance of evidence-based approaches to address the challenges posed by Gen-AI such as ChatGPT in pharmacy education settings. Additionally, whilst mitigation strategies are suggested, primarily drawn from the grey literature, there is a paucity of traditionally published scientific literature outlining strategies for the practical and ethical implementation of Gen-AI within pharmacy education. Further research related to the responsible and ethical use of Gen-AIin pharmacy curricula; and studies related to strategies adopted to mitigate risks to academic integrity would be beneficial., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The author is an Editorial Board Member/Editor-in-Chief/Associate Editor/Guest Editor for ERCSP] and was not involved in the editorial review or the decision to publish this article. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The co-author for this scoping review is an Associate Editor for ERCSP journal. There are no financial interests to be considered., (© 2024 The Authors.)

Background: The prevalence and burden of mental illness among young people is rising, globally. Youth mental health services, such as headspace , offer young people access to multidisciplinary mental healthcare, specifically designed to address their needs. Pharmacists are medicines experts and possess a skillset increasingly being utilised in expanded areas of practice. There is potential for pharmacists to perform roles within youth mental health services, however sparse literature exploring pharmacist-delivered mental healthcare for young people exists., Objective: To explore views of headspace staff on medication use among young people who use youth mental health services and pharmacists' potential roles within the headspace youth mental health service model., Methods: Individual semi-structured interviews were conducted with staff from one inner city headspace centre in Sydney, Australia. An interview guide was developed to capture participants' views on medication use among young people using youth mental health services and potential roles for pharmacists within this context. Reflexive thematic analysis was conducted to analyse the findings of this exploratory pilot study., Results: Twelve staff members were interviewed, allowing for a range of multidisciplinary perspectives. Four themes were identified from the data: (i) gaps in medication-related care, (ii) potential roles for pharmacists at headspace (iii) collaboration between pharmacists and general practitioners, and (iv) a "one-stop shop"., Conclusions: There are opportunities for pharmacists to improve young peoples' experiences using psychotropic medications through the provision of medication information to clients and caregivers. Pharmacists have a potential role to play in contributing to multidisciplinary case reviews but clarifying their specific roles when working alongside general practitioners is necessary. Uncertainty regarding the feasibility of pharmacist-led services within the headspace youth mental health service model and a lack of awareness regarding pharmacists' full scope of practice are barriers to pharmacists' potential roles within the headspace model., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Selective cyclooxygenase-2 inhibitor anti-inflammatory drugs (coxibs) are associated with the development of adverse events, mainly gastrointestinal and cardiovascular, but renal effects are less known., Objective: To assess the renal risks of coxibs compared to placebo by means of a systematic review and meta-analysis., Methods: Randomized controlled trials that assessed renal effects of coxibs (celecoxib, etoricoxib, lumiracoxib, parecoxib, and valdecoxib) were searched in PubMed, Embase, Scopus and other sources up to March 2024. Two independent reviewers performed study screening, data extraction, and risk of bias assessment. Random effect meta-analysis was employed to calculate the relative risks (RR) and 95% confidence intervals (CI) of renal effects of coxibs compared to placebo and inconsistency among studies ( I 2 ). Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach., Results: Out of 5284 retrieved records, 49 studies (comprising 46 reports) were included. Coxibs increased the risk of edema (RR 1.46; 95% CI 1.15, 1.86; I 2  = 0%; 34 studies, 19,754 participants; moderate-certainty evidence), and celecoxib increased hypertensive or renal events (RR 1.24; 95% CI 1.08, 1.43; I 2  = 0%; 2 studies, 3589 participants; moderate-certainty evidence). Etoricoxib increased the risk of hypertension (RR 1.98; 95% CI 1.14, 3.46; I 2  = 34%; 13 studies, 6560 participants; moderate-certainty evidence); no difference was observed when pooling all coxibs (RR 1.26; 95% CI 0.91, 1.76; I 2  = 26%; 30 studies, 16,173 participants; moderate-certainty evidence)., Conclusions: Coxibs likely increase the renal adverse effects, including hypertension and edema. Awareness about the renal risks of coxibs should be increased, mainly in high-risk patient., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: The pharmacy sector is rapidly evolving due to technological advancements, presenting challenges and opportunities for pharmacists. However, limited literature exists on the future of pharmacy work, especially concerning technology adoption., Objective: This exploratory study investigates pharmacists' perspectives on the impact of technologies on the profession - including career security, role evolution, adjustments to changes - and the impact of the COVID-19 pandemic on technology implementation and the broader future of work in pharmacy., Method: A cross-sectional survey design was used, targeting all registered pharmacists in New Zealand. A questionnaire, adapted from Future of Work literature, was piloted and distributed to 3037 pharmacists. Data were analyzed using descriptive statistics, two-step hierarchical analysis, and content and thematic analysis. Ethics approval was obtained., Results: 177 responses met the inclusion criteria, yielding a 5.82% response rate. Respondent demographics included a lower proportion of community pharmacists and individuals of Asian ethnicity, but a higher proportion of males and hospital pharmacists compared to the national workforce. Most respondents were aged between 30 and 59 years, representing all District Health Board locations.Qualitative analysis identified two themes: 1) Factors affecting technology adoption across macro, meso and micro levels, including COVID-19's impact on work efficiency, regulatory gaps, fragmented IT and organizational infrastructures, patient safety, and attitudes at workforce and individual levels; 2) Career impacts, highlighting role expansion, job replacement fears, and the need for adaptation and upskilling. Quantitative findings indicate that early technology adopters are more prepared to learn new skills and plan their careers. Technology impact positively correlates with career planning, while job loss concerns negatively affect skill development readiness., Conclusion: The study underscores the importance of early technological adoption for readiness to acquire new skills and career planning in pharmacy. Embracing technological change, supported by regulatory and policy frameworks, is crucial for advancing the profession., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Introduction: The problem of drug shortages is not new, but it has reached unprecedented levels in recent years. In community pharmacies, pharmacists are forced to develop daily strategies to deal with such shortages and ensure patient care. These efforts result in significant constraints and adjustments to pharmacists' daily practices. The aim of this study is to explore the possible relationship between the consequences of drug shortages and the well-being of pharmacists in pharmacies., Material & Method: This study adopts an exploratory qualitative approach by interviewing pharmacists working in community pharmacies in Wallonia. The data were collected between March and June 2023 through individual semi-structured interviews using a resolute guide. The interview guide was adapted as the interviews progressed and according to the pharmacists' views. 16 participants were included, including 7 owner pharmacists, 3 non-owners, and 6 non-titular pharmacists. The interviews were transcribed and then analyzed through a thematic approach., Results: An in-depth study of the day-to-day reality of pharmacies that is open to the public highlights the time-consuming nature of drug shortages, with various implications for pharmacists' relationships, finances, and workload. However, these professionals also highlight the recognition of patients when a solution is discovered, with some sources saying that shortages value the pharmacist's ability and enhance the profession. Finally, about the possibility of change in the training of pharmacists is also addressed by some pharmacists., Conclusion: Drug shortages demand changes in pharmaceutical practice and appear to affect the well-being of pharmacists in public settings. However, the impact seems complex and is amplified by the lack of personnel. With shortages continuing to rise in recent years, it would be wise to analyze the longer-term effects of this phenomenon., Competing Interests: X The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Digital healthcare has rapidly evolved during and in the post-COVID pandemic era, expanding the roles and responsibilities of community pharmacists. Services like telepharmacy, e-prescriptions, remote medication therapy management, and digital monitoring of chronic conditions, have evolved into everyday routine pharmacy practices. Pharmacists are at the forefront and the most accessible healthcare professionals for patients and are increasingly pivotal in providing comprehensive patient care, including digital patient care services. To ensure that future generations of pharmacists are digitally competent, it is crucial that digital health education is provided to pharmacy students. Furthermore, fostering high-quality multidisciplinary research, particularly in collaboration with medicine and other health disciplines, is essential for advancing the digital health skills of the future pharmacy workforce. Despite the growing use of digital health technologies, there are significant between-country differences in digital health education, the clinical settings in which digital health technologies are used, and their implementation in day-to-day practice. This commentary summarizes key insights from the International Digital Health Workshop held at the University of Sydney in November 2023. To help ensure pharmacists are included as participants in future digital health research, recent advances in digital health education and interprofessional research projects across three universities from far-off world regions were presented. Participants discussed a possible collaborative, interprofessional, and international research project on chronic disease prevention using digital health technologies. The need for interdisciplinary digital health curricula was highlighted in the workshop discussions, specifically tailored to address the knowledge requirements of pharmacists and other healthcare professionals., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Visual impairment can significantly affect a person's ability to take medications safely. Therefore, pharmacists need to ensure safe and effective access to medication information, particularly through the use of assistive products, which are devices that compensate for partial or total vision loss. Although assistive products are used by visually impaired patients for activities of daily living, their use in medication management needs to be more widespread., Objective: The study aimed to investigate community pharmacists' opinions and excpectations on the use of assistive products in pharmacy practice to optimize and secure medications use for visually impaired patients. The goal is to transfer these assistive products to pharmacy practice., Methods: Focus groups were conducted with 6 French-speaking community pharmacists via videoconference in Belgium, following the principle of participatory action-research. The participants were recruited voluntarily, and moderator's guides were developed to lead the discussion. The focus groups were recorded, transcribed verbatim, and analyzed in a double-blind fashion using thematic analysis. The data were organized by NVivo software., Results: Four themes were identified: easy-to-use assistive products according to pharmacists, usefulness of assistive products in pharmacy practice, barriers to the use of assistive products, and potential solutions. According to community pharmacists, certain assistive products were deemed easy-to-use and transferable to pharmacy practice., Conclusions: This qualitative study demonstrates the transferability of assistive products to pharmacy practice for visually impaired patients in medications use. The study taken into account the patient's profile and the multidisciplinary approach, which community pharmacists consider essential., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: The advent of Large Language Models (LLMs) such as ChatGPT introduces opportunities within the medical field. Nonetheless, use of LLM poses a risk when healthcare practitioners and patients present clinical questions to these programs without a comprehensive understanding of its suitability for clinical contexts., Objective: The objective of this study was to assess ChatGPT's ability to generate appropriate responses to clinical questions that hospital pharmacists could encounter during routine patient care., Methods: Thirty questions from 10 different domains within clinical pharmacy were collected during routine care. Questions were presented to ChatGPT in a standardized format, including patients' age, sex, drug name, dose, and indication. Subsequently, relevant information regarding specific cases were provided, and the prompt was concluded with the query "what would a hospital pharmacist do?". The impact on accuracy was assessed for each domain by modifying personification to "what would you do?", presenting the question in Dutch, and regenerating the primary question. All responses were independently evaluated by two senior hospital pharmacists, focusing on the availability of an advice, accuracy and concordance., Results: In 77% of questions, ChatGPT provided an advice in response to the question. For these responses, accuracy and concordance were determined. Accuracy was correct and complete for 26% of responses, correct but incomplete for 22% of responses, partially correct and partially incorrect for 30% of responses and completely incorrect for 22% of responses. The reproducibility was poor, with merely 10% of responses remaining consistent upon regeneration of the primary question., Conclusions: While concordance of responses was excellent, the accuracy and reproducibility were poor. With the described method, ChatGPT should not be used to address questions encountered by hospital pharmacists during their shifts. However, it is important to acknowledge the limitations of our methodology, including potential biases, which may have influenced the findings., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

The widespread adoption of wearable devices (wearables) for monitoring vital signs, including blood pressure and glucose levels, has experienced a considerable surge in recent times. This surge has led to the generation of a substantial amount of health data, accessible to pharmacists during patient consultations as the healthcare sector advances in digitalization. To enhance the digital competencies of future pharmacists required by the rapidly changing digital health landscape, the Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University (HHU) Duesseldorf has developed an innovative elective practical course aimed to bolster pharmacy students' competencies in handling wearables and the health data generated. The three-week practical elective course employed wearables FreeStyle Libre® 3 (Continuous Glucose Monitoring, CGM) and Aktiia (Cuffless Blood Pressure Monitoring). The hands-on activities allowed participants to obtain and interpret wearable-generated health-related data and acquainted them with simulated patient cases. Final-year pharmacy students' subjective assessments before and after the course depicted the increased knowledge and competence regarding analysing wearables data., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)