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Kiran Shahbaz,1 Alamgeer,1 Vibhu Paudyal,2 Maryam Zubair,3 Maryam Zahra Safdar,4 Momina Tahir,4 Laraib Akram,4 Salamat Ali4 1Department of Pharmacology, University College of Pharmacy, University of the Punjab Lahore, Pakistan; 2Institute of Clinical Sciences, University of Birmingham, Edgbaston Birmingham, UK; 3Faculty of Experimental Medicine Orebro University, Sweden; 4Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, GC University Faisalabad, Faisalabad, PakistanCorrespondence: Salamat Ali, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, GC University Faisalabad, Faisalabad, Pakistan, Tel +00-92-3004189052; +00-92-041-9201036, Email drsalamatali@gcuf.edu.pkBackground: Prevalence of psychological disorders among individuals with diabetes is significantly higher as compared to the general population.Aim: This study aimed to assess the prevalence and impact of psychological disorders on pharmacotherapy of diabetes patients.Methodology: This cross-sectional study was conducted at two primary care hospitals in Pakistan from April to June 2023. The nine-item Patient Health Care Questionnaire (PHQ-9) scale was used to assess depression in the study’s population, and its effects on pharmacotherapy of diabetes. Chi-square test was used to evaluate relationship between ordinal variables/categorical variables and depression whereas; Student’s t-test was used to assess the relationship between numerical variables with depression.Results: A total of 320 patients were assessed, comprising 120 (37.5%) males and 200 (62.5%) females, with a mean age of 52.5 (SD± 11.8) years. The average duration of diabetes is 7.0 (SD± 5.4). The average PHQ-9 score was 8.3 (SD± 5.5). Depression was found to be prevalent in 43.7% of the study population. Gender (female) (p-value 0.002), advanced age (p-value 0.002), lower income (p-value 0.001), education levels (p-value 0.001), longer duration of diabetes (p-value 0.001), poor diabetes control according to BSR value (p-value 0.001), usage of injectable insulin (p-value 0.005), and concomitant diseases (p-value 0.001) were found to be independently linked with depression. Significant association was observed between depression and treatment adherence (p-value 0.0025), number of missed doses (p-value 0.045), and difficulty in diabetes management (p-value 0.0015).Conclusion: Our study highlights significant prevalence of depression in study population and the prevalent depression negatively impacts on treatment adherence. It also revealed that depression complicates diabetes management resulting in poor medication adherence, poor diabetes control and diabetes related complications, making diabetes control more challenging and difficult.Keywords: psychological disorders, diabetes, pharmacotherapy, PHQ-9

Nabin Pathak,1,2 Shreya Dhungana,3 Bijaya Basyal,4 Prabhat Kumar Jha,5 Sunil Shrestha,6 Panna Thapa,7,8 Vibhu Paudyal9,10 1Drug Information Unit and Pharmacovigilance Cell, Department of Pharmacy, Hetauda Hospital, Madan Bhandari Academy of Health Sciences, Hetauda, Bagmati Province, Nepal; 2Department of Pharmacy and Clinical Pharmacology, Madan Bhandari Academy of Health Sciences, Hetauda, Bagmati Province, Nepal; 3Department of Pharmacy, National Model College for Advanced Learning, Tribhuvan University, Kathmandu, Nepal; 4Pharmacy Unit, Prithvi Chandra Hospital, Nawalparasi, Nepal; 5Pharmacy Officer, Province Health Logistic Management Center, Dhanusha, Nepal; 6Department of Research and Academics, Kathmandu Cancer Center, Bhaktapur, Province Bagmati, Nepal; 7Department of Pharmacy, Kathmandu University, Dhulikhel, Kavre, Nepal; 8Multidimensional Cannabis Research Centre (MCRC), Kathmandu University, Dhulikhel, Nepal; 9School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK; 10Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UKCorrespondence: Nabin Pathak, Drug Information Unit and Pharmacovigilance Cell, Department of Pharmacy, Hetauda Hospital, Madan Bhandari Academy of Health Sciences, Makwanpur, Hetauda, Bagmati Province, Nepal, Email nabin.pathak@mbahs.edu.np; pathaknabin89@gmail.comAbstract: The unique historical and cultural background of Nepal has shaped its perspective on cannabis usage. Narcotic Drugs Control Act 1976 of Nepal prohibits the cultivation, production, manufacture, sales, and distribution of narcotic drugs, which also include various forms of cannabis. With proponents for cannabis legalization increasing in the country, it is equally crucial to analyze context and practices in countries already adopting legalization. As such, this article contextualizes the current debates in Nepal with global policies and practices and talks about the possible impacts of changing the laws on society, the economy, and public health. Policymakers in Nepal must make decisions based on evidence and facts when deciding how to regulate cannabis.Keywords: cannabis, legalization, decriminalization, Nepal

Sunil Shrestha,1 Asmita Priyadarshini Khatiwada,2 Binaya Sapkota,3 Simit Sapkota,4,5 Prabhat Poudel,6 Bhuvan KC,7,8 Siew Li Teoh,1 Ali Qais Blebil,1 Vibhu Paudyal9 1School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, 47500, Malaysia; 2Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA; 3Department of Pharmaceutical Sciences, Nobel College, Kathmandu, Nepal; 4Department of Clinical Oncology, Civil Service Hospital, Minbhawan, Kathmandu, Bagmati Province, Nepal; 5Department of Clinical Oncology, Kathmandu Cancer Center, Tathali, Bagmati Province, Nepal; 6Nepal Medical College Hospital, Kathmandu, Province Bagmati, Nepal; 7College of Public Health, Medical & Veterinary Sciences, James Cook University, Townsville, QLD, Australia; 8Faculty of Pharmacy and Pharmaceutical Sciences Monash University Parkville Campus Parkville, Melbourne, VIC 3052, Australia; 9School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UKCorrespondence: Sunil Shrestha; Vibhu Paudyal, Tel +60 102874113, Email Sunil.shrestha@monash.edu; sunilcresta@gmail.com; v.paudyal@bham.ac.ukIntroduction: Opioid stewardship has been widely used to promote rational use, monitoring and discontinuation of opioid therapy; however, its definition and scope of practice remain unclear.Objective: To synthesize definitions of opioid stewardship proposed by clinical practice guidelines and professional societies, and to offer a proposal for a universally acceptable definition.Methods: Systematic literature searches were performed (earliest records to May 2022) in six databases (MEDLINE, EMBASE, APA PsycINFO, Scopus, and CENTRAL) and grey sources guidelines development bodies and professional societies through Google. The conventional but widely applied content analysis and word frequencies were used to analyze the definitions and scope of practice.Results: After removing duplicates, 449 articles were retrieved (439 databases and registers and 11 from other sources), 19 of which included a definition of “opioids stewardship”. A total of 12 themes was identified in the definitions, including 1) improvement or appropriateness of prescribing opioids use, 2) mitigation of risk from opioids, 3) monitoring opioid use, 4) evaluation of opioid use, 5) judicious opioid use, 6) appropriateness of opioid disposal, 7) identification and treatment of opioid use disorder, 8) reduction in mortality associated with opioid overdoses, 9) appropriate procurement practices, 10) appropriate storage, 11) promoting better communications between patients and prescribers including education provision and 12) patient-centered decision-making.Conclusion: Opioid stewardship is inconsistently defined across professional and research literature. While there is a greater focus on appropriateness and need for improvement of prescribing and monitoring of opioid use, the importance of communications between patients and prescribers, and patient involvement in both prescribing and deprescribing decision-making remains sparse. A comprehensive definition has been proposed as part of the work. There is a need to develop and validate the proposed definition and scope of practice to promote rationale for opioid prescribing, use and attainment of favourable outcomes through international consensus involving practitioners, researchers, and patients.Keywords: opioid, opioid stewardship, opioid stewardship definition, stewardship

Aziza Alenezi, Asma Yahyouche, Vibhu Paudyal University of Birmingham, School of Pharmacy, Institute of Clinical Sciences, Birmingham, B15 2TT, UKCorrespondence: Asma Yahyouche, School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK, Tel/Fax + 44121 415 8798, Email A.Yahyouche@bham.ac.ukPurpose: In view of concerns about the harmful effects of long-term use and patient misuse of opioids in chronic non-malignant pain, this study provides insight into patients’ perspectives on their experience of living with chronic non-malignant pain (CNMP), prescribed opioid use, and optimisation.Patients and Methods: Data were collected from active UK-based CNMP specific or general health forums that do not require registration, with more than 100 members. English written thread posts between 2016 and 2020 were systematically searched from the forum search bar using different keywords and then analysed using the Theoretical Domains Framework (TDF).Results: Findings showed that chronic pain is a dominant, life-altering experience with physical, psychological and social impact. Findings highlighted that opioid optimisation is facilitated by patients’ knowledge and understanding, practical coping strategies and supportive relationships with healthcare providers and others in their surroundings. The study found that barriers to opioid optimisation included lack of availability of alternatives, difficulties accessing health services and broken relationships with clinicians.Conclusion: Analysis of CNMP patients’ posts on online forums highlighted the devastating impact of pain on social functioning, relationships and mental health. Patients emerged as knowledge seekers prepared to engage in opioid optimisation.Keywords: chronic non-malignant pain, medication optimisation, patient perspective, prescribed opioids, theoretical domains framework, qualitative study

Rajina Shakya,1,* Rajeev Shrestha,2,* Sunil Shrestha,3,* Priti Sapkota,1 Roshani Gautam,4 Lalita Rai,4 Asmita Priyadarshini Khatiwada,5 Kamal Ranabhat,6,7 Bhuvan KC,3 Binaya Sapkota,8 Saval Khanal,9 Vibhu Paudyal10 1Department of Nursing, Nobel College, Kathmandu, Province Bagmati, Nepal; 2Department of Pharmacy, District Hospital Lamjung, Lamjung, Province Gandaki, Nepal; 3School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia; 4Department of Nursing, Tribhuvan University, Maharajgunj Nursing Campus, Kathmandu, Nepal; 5Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Province Bagmati, Nepal; 6Center Department of Public Health, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal; 7Ministry of Health and Population, Kathmandu, Nepal; 8Department of Pharmaceutical Sciences, Nobel College, Affiliated to Pokhara University, Kathmandu, Province Bagmati, Nepal; 9Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK; 10School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK*These authors contributed equally to this workCorrespondence: Rajeev Shrestha, Department of Pharmacy, District Hospital Lamjung, Besisahar, Province Gandaki, Nepal, Tel +977 9845445205, Email rajiv2stha@gmail.com Sunil Shrestha, School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Subang Jaya, Selangor, Malaysia, Tel +60 102874113, Email sunil.shrestha@Monash.eduBackground: Control of high blood pressure and prevention of cardiovascular complications among hypertensive patients depends on patients’ adherence to therapy. The Hill–Bone Compliance to High Blood Pressure Therapy Scale (HBCTS) is one of the most popular scale to assess hypertensive patients’ adherence behaviour. Unfortunately, no questionnaire in the Nepalese language is available to date to assess adherence to anti-hypertensive therapy.Aim: To translate, culturally adapt and validate the English original version of the HBCTS into Nepalese language to measure treatment adherence of Nepalese hypertensive patients.Methods: The cross-sectional study was conducted to translate, culturally adapt and validate the HBCTS into Nepalese version. The standard translation process was followed and was evaluated among 282 hypertensive patients visiting selected primary healthcare centers (PHCCs) of Kathmandu district, Nepal. Cronbach’s alpha was measured to assess the reliability of the tool. Exploratory factor analysis using principal component analysis with varimax rotation was used to evaluate structural validity.Results: The mean±SD age of 282 participants was 58.49± 12.44 years. Majority of participants were literate (75.2%), and consumed at least one anti-hypertensive medication per day (85.5%). Nearly half (42.2%) of the participants had a family history of hypertension, and almost half (48%) of them had comorbid conditions. Mean ±SD score for overall adherence was 17.85± 3.87 while those of medication taking, reduced salt taking, and appointment keeping subscales were 10.63± 2.55, 4.16± 1.12 and 3.06± 1.07, respectively. Kaiser Meyer Olkin (KMO) was found to be 0.877. Exploratory factor analysis revealed a three-component structure; however, the loading of components into medication adherence, reduced salt intake and appointment keeping constructs were not identical to the original tool. Cronbach’s alpha score for the entire HBCTS scale was 0.846.Conclusion: The translated Nepali version of the HBCTS demonstrated acceptable reliability and validity to measure adherence to antihypertensive therapy among hypertensive patients in clinical and community settings in Nepal.Keywords: cultural adaptation, Hill–Bone scale, hypertension, Nepal, treatment adherence, translation

Hamzeh Mohammad Alrawashdeh,1,&ast; Abdallah Y Naser,2,&ast; Hassan Alwafi,3,4 Amal Khaleel AbuAlhommos,5 Zahra Jalal,6 Vibhu Paudyal,6 Dina M Abdulmannan,3 Fadi Fouad Hassanin,7 Sara Ibrahim Hemmo,2 Fawaz Al Sarireh8 1Department of Ophthalmology, Sharif Eye Centers, Irbid, Jordan; 2Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan; 3Faculty of Medicine, Umm Alqura University, Mecca, Saudi Arabia; 4Alnoor Specialist Hospital, Ministry of Health, Mecca, Saudi Arabia; 5Pharmacy Practice Department, Clinical Pharmacy College, King Faisal University, Alhasa, Saudi Arabia; 6School of Pharmacy, University of Birmingham, Birmingham, UK; 7Department of Medicine, University of Jeddah, Jeddah, Saudi Arabia; 8Department of Ophthalmology, College of Medicine, University of Mutah, Karak, Jordan&ast;These authors contributed equally to this workCorrespondence: Abdallah Y Naser; Hamzeh Mohammad Alrawashdeh, Email abdallah.naser@iu.edu.jo; dr_hmsr@yahoo.comPurpose: To investigate the trends of hospital admissions concerning diseases of the eye and adnexa in the United Kingdom in the past 20 years.Materials and Methods: An ecological study was conducted using hospital admission data taken from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. Hospital admissions data for diseases of the eye and adnexa were extracted for the period between April 1999 and March 2019. The trend in hospital admissions was assessed using a Poisson model.Results: Hospital admission rate for diseases of the eye and adnexa increased by 73.8% [from 7.48 (95% CI 7.45– 7.50) in 1999 to 13.00 (95% CI 12.97– 13.02) in 2019 per 1000 persons, trend test, p < 0.001]. The most common cause of hospitalisation for diseases of the eye and adnexa was disorders of the lens (62.3%), followed by disorders of the choroid and retina (14.2%), followed by disorders of the eyelid, lacrimal system and orbit (11.5%). Hospital admission rate among males increased by 91.2% [from 6.19 (95% CI 6.16– 6.22) in 1999 to 11.83 (95% CI 11.80– 11.87) in 2019 per 1000 persons]. Hospital admission rate among females increased less sharply by 63.2% [from 8.71 (95% CI 8.68– 8.75) in 1999 to 14.22 (95% CI 14.18– 14.26) in 2019 per 1000 persons].Conclusion: There are clear gender and age trends in the epidemiology of hospital admissions related to eye and adnexa disorders. Further observational studies are warranted to identify other risk factors for these important causes of hospitalisation and understanding of differential trends.Keywords: admission rate, adnexa, ecological study, England, eye, hospitalisation, United Kingdom, Wales

Umaani Rauf,1 Majid Ali,2 Inderpal Dehele,1 Vibhu Paudyal,1 Mohamed Hassan Elnaem,3,4 Ejaz Cheema1 1School of Pharmacy, University of Birmingham, Birmingham, B15 2TT, UK; 2Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia; 3Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia; 4Quality Use of Medicines Research Group, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, MalaysiaCorrespondence: Ejaz CheemaSchool of Pharmacy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UKTel +44 121-4146845Email E.Cheema@bham.ac.ukObjective: Mortalities due to fentanyl derivatives are on the rise with novel fentanyl analogues and still emerging on the global illicit drug market. They are highly potent and very fatal in low doses, yet there has been a lack of systematic research surrounding this subject. This review aims to assess the causes, nature, and toxicology of fatalities associated with fentanyl analogues.Methods: Five databases: Scopus, Embase, Medline, PubMed and Google Scholar were searched from inception to October 2020 to identify case studies and case series reporting fentanyl analogue-related fatalities. Two independent reviewers screened and selected the articles followed by the data extraction from each article, which included demography, route of administration, causes and nature of death, and the fentanyl analogue implicated. All articles were then subject to quality assessment tools developed by the Joanna Briggs Institute (JBI). A narrative synthesis was undertaken.Results: The initial data search yielded 834 articles, only 14 of which met the inclusion criteria – this included nine case reports and five case series. Of the 1079 fentanyl-analogue related deaths reported, the majority of them occurred in the US (n=1044, 96.8%). The majority of fatalities were male (n=766, 71%), white (n=884, 87%) and in the age ranges 25– 34 and 35– 44 years (30.5% and 29.6%, respectively). The most common route of administration was intravenous (n=319, 66%) and the manner of death was almost exclusively accidental (99.7%). The predominant cause of death was fentanyl-analogue toxicity (n=292, 85.4%) and involved mixed drug toxicity (n=47, 13.7%). The mean post-mortem fentanyl analogue concentration was 31.6 ng/mL.Conclusion: Most fatalities were reported in the US involving young white males. Overdose through intravenous administration and by mixed drug toxicities with other opioids were the major causes of death. Deaths reported in peer-reviewed literature were relatively less than those reported by real-world data.Keywords: fentanyl-analogues, fatalities, systematic review, case series, case reports

Rajeev Shrestha,1,&ast; Binaya Sapkota,2,&ast; Asmita Priyadarshini Khatiwada,3 Sunil Shrestha,4,&ast; Saval Khanal,5 Bhuvan KC,4 Vibhu Paudyal6 1Department of Pharmacy, District Hospital Lamjung, Besisahar, Province Gandaki, Nepal; 2Department of Pharmaceutical Sciences, Nobel College, Affiliated to Pokhara University, Kathmandu, Province Bagmati, Nepal; 3Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Province Bagmati, Nepal; 4School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, 47500, Malaysia; 5Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK; 6Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK&ast;These authors contributed equally to this workCorrespondence: Rajeev ShresthaDepartment of Pharmacy, District Hospital Lamjung, Besisahar, Province Gandaki, NepalTel +977-9845445205Email rajiv2stha@gmail.comBinaya SapkotaDepartment of Pharmaceutical Sciences, Nobel College, Affiliated to Pokhara University, Kathmandu, Province Bagmati, NepalTel +977-9851134925Email sapkota.binaya@gmail.comBackground: The General Medication Adherence Scale (GMAS) evaluates intentional and unintentional behaviour of patients, disease and medication burden and cost-related burden associated with non-adherence. GMAS was developed and validated among Urdu-speaking patients with chronic diseases. However, validated tool in Nepalese language to measure medication adherence among chronic illness patients currently does not exist.Aim: To translate, culturally adapt, and validate the English version of GMAS into the Nepalese language to measure medication adherence among chronic illness patients.Methods: The study was conducted among patients with chronic diseases in both hospital and community pharmacies of Nepal. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Good Practice Guideline for linguistic translation and cultural adaptation was used to translate and culturally adapt the English version of GMAS into the Nepalese version. The translated version was validated amongst patients with chronic diseases in Nepal. Exploratory factor analysis was carried out using principal component analysis with varimax rotation. Test–retest reliability and internal consistency were analysed.Results: A total of 220 (53.6% females, and 51.4% of 51 to 70 aged patients) patients with chronic diseases participated in the study. The majority of patients took two medications (27.3%) from six months to five and half years (68.2%). Kaiser Meyer Olkin was found to be 0.83. A principal axis factor analysis was conducted on the 3 items of GMAS without and with orthogonal rotation (varimax). The scree plot showed an inflexion on the third item that meant three components were present. The overall Cronbach’s alpha value of the full-phase study was 0.82.Conclusion: The General Medication Adherence Scale was successfully translated into the Nepalese language, culturally adapted, and validated amongst chronic diseases patients of Nepal. Therefore, the GMAS-Nepalese version can be used to evaluate medication adherence among Nepalese-speaking patients with chronic disease.Keywords: adherence, chronic disease, general medication adherence scale, GMAS, Nepal, psychometric validation

Ejaz Cheema,1 Khalil McGuinness,1 Muhammad Abdul Hadi,1 Vibhu Paudyal,1 Mohammed Hassan Elnaem,2 Abdullah A Alhifany,3 Mahmoud E Elrggal,3 Abdullah Al Hamid1 1School of Pharmacy, University of Birmingham, Birmingham, UK; 2Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University, Kuantan, Malaysia; 3Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Kingdom of Saudi ArabiaCorrespondence: Ejaz CheemaSchool of Pharmacy, University of Birmingham, Room 356, Robert Aitken Building, Edgbaston, Birmingham B15 2TT, UKEmail e.cheema@bham.ac.ukPurpose: Fentanyl poisoning has been widely reported, yet there is a lack of systematic evaluation of the nature and toxicology of associated deaths in the published literature. This article aims to systematically review the nature, causes, routes of administration and toxicology of fentanyl-associated deaths using case studies and case series in peer-reviewed published literature.Methods: Four electronic databases including Embase, Medline (via Ovid), Scopus and Google Scholar were searched from inception until October 2019 to identify the studies reporting fentanyl related deaths. Two independent reviewers screened and selected the titles and then evaluated the full texts. Only case studies and case series were included. A structured data extraction tool was used to extract data on the number of deaths, routes of administration, concomitant drug use and toxicological data. The Joanna Briggs Institute quality assessment tool was used to evaluate the quality of included studies. Data were synthesized narratively.Results: Of 1251 articles identified during initial search, 8 case reports and 9 case series met the inclusion criteria. A total of 1969 deaths were reported in the included studies. Deaths were concentrated in the north American region (n = 1946) and the Nordic region (n = 22). Reported causes of death included fentanyl overdose (n = 321, 56.4%), mixed drug toxicity (n = 196, 34.5%), natural (n = 28, 4.9%), other drug toxicity (n = 10, 1.8%), fentanyl and ethanol intoxication (n = 8, 1.4%), incidental (n = 5, < 1%) and aspiration (n = 1). Most common routes of use were intravenous (70.5%) and transdermal routes (23.0%). Deaths came swiftly via the intravenous route. Mean level of blood fentanyl amongst all reported deaths was 0.024 μg/mL.Conclusion: Literature related to fentanyl-associated deaths predominantly come from North America. Deaths are comparatively lower or not reported in peer-reviewed publications from the rest of the world. Abuse through intravenous administration, mixed drug toxicities and self-treatment of breakthrough pain are mainly responsible for majority of the reported deaths.Keywords: fentanyl, death, nature, cause, toxicology

Salamat Ali,1,2 Mashhood Ali,3 Vibhu Paudyal,4 Faisal Rasheed,5 Shahan Ullah,1 Sayeed Haque,6 Tofeeq Ur-Rehman1 1Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan; 2Services Institute of Medical Sciences, Lahore, Pakistan; 3Department of Gastroenterology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan; 4School of Pharmacy, University of Birmingham, Birmingham, UK; 5Pakistan Institute of Nuclear Sciences and Technology, Islamabad, Pakistan; 6Institute of Applied Health Research Medical Statistics, University of Birmingham, Birmingham, UKCorrespondence: Tofeeq Ur-RehmanDepartment of Pharmacy, Quaid-I-Azam University, Islamabad, PakistanTel +92 51 9064 4135Email tofeeq.urrehman@qau.edu.pkPurpose: The role of specialized pharmacy services remains unexplored in clinical practice for hepatitis C patients in Pakistan. This study aimed to evaluate the impact of clinical pharmacy interventions on treatment outcomes, health-related quality of life (HRQoL), and medication adherence among hepatitis C patients.Methods: A randomized control trial was conducted at two tertiary-care teaching hospitals in Pakistan. Hepatitis C patients who attended the outpatient clinics between October 2015 and September 2018 were randomized to two groups [usual care (UC) and pharmaceutical care (PC)] in a 1:1 ratio, applying simple envelope method. The PC group received pharmaceutical care led by a clinical pharmacist. The care that patients received included education and counseling on medication compliance, labeling of medication packs, and monitoring of adverse drug events, led by a qualified clinical pharmacist during the 15- to 20-minute monthly sessions, while the UC group received standard care at hospital, which did not involve clinical pharmacist input. Outcome measures, such as sustained virological response, HRQoL, and adherence rate (pharmacy data) were assessed at enrolment and distinct time intervals: 4 weeks, 8 weeks, and end of treatment.Results: A total of 931 patients were included in the study (UC 466 and PC 465), with mean age 42.35±1.9 years. Sustained virological response at 12 weeks was achieved in 86.0% patients in the PC group, significantly (p

Background: Simvastatin 10 mg was reclassified in 2004 to over-the-counter (OTC) status in the UK, indicated for the prevention of a first major coronary event in individuals at moderate risk of the event. The primary reason behind the reclassification was to reduce the burden of disease management in general practice. Community pharmacists' adoption of OTC simvastatin into practice immediately post reclassification was reported to below but there has been no systematic update on current practice.Objective: The aim was to investigate pharmacists' adoption into practice, and attitudes to, OTC simvastatin 5 years post reclassification in the UK.Setting: Community pharmacists at all community pharmacies in Scotland.Method: A pre-piloted postal questionnaire was distributed to all community pharmacies in Scotland (N = 1138). Self rated adoption was measured on a five point scale. Factors associated with decision making were investigated using a 24-item Likert-type agreement scale.Main Outcome Measure: Pharmacists' perceived integration of reclassified simvastatin; factors associated with decision making.Results: Response rate was 49.5 % (n = 563). A high majority reported not supplying the reclassified medicine mainly owing to a perceived lack of evidence, low patient demand, customer complaints about the retail price and lack of access to patient medical records. A minority agreed to reclassification being an opportunity for their role development.Conclusions: Community Pharmacists' views of reclassified simvastatin supply 5 years post reclassification, as compared to the time it was newly reclassified, suggest low uptake. This lack of progress over time suggests that, against policy initiatives, OTC availability is unlikely to have impacted on the level of general practice led management of patients at risk of coronary events. [ABSTRACT FROM AUTHOR]

Background: Health education in primary schools plays a critical role in equipping children with essential self-care skills, fostering health literacy, and addressing social determinants of health. This study explores the perspectives of parents and teachers on teaching self-care and managing common health issues in UK primary schools. Despite the recognized importance of health education, there is limited research on how self-care education is perceived and implemented in the primary school setting., Methods: A qualitative study was conducted using semi-structured interviews with 18 participants, including 9 generalist primary teachers and 9 parents from diverse educational and socioeconomic contexts in the West Midlands, East Midlands, Northwest, and London of England. Participants were recruited via social media and professional networks, and interviews were conducted via video conferencing platforms. Data were thematically analysed using NVivo 12 to identify recurring themes related to the delivery and impact of self-care education in primary schools., Results: Teachers and parents highlighted key self-care topics, including hygiene, managing common illnesses like colds and cuts, and mental well-being. There was a consensus on the importance of self-care education, but views diverged on whether the responsibility should lie primarily with schools, parents, or a collaborative approach. Teachers expressed concerns about their preparedness to teach sensitive topics, citing a lack of training and resources. Socioeconomic and religious contexts further influenced perceptions, with participants emphasising further importance of school-led self-care education for children from lower socioeconomic backgrounds. Strengths were identified in current self-care education efforts, particularly in practical lessons that empower children with age-appropriate skills., Conclusions: This study highlights the critical need for comprehensive and collaborative health education in primary schools to promote health literacy and reduce health disparities. Enhancing teacher training, integrating self-care topics into the primary curriculum, and fostering stronger partnerships between schools and families are essential to improving the quality and consistency of self-care education. Policymakers should consider implementing mandatory health education training in teacher education programs and providing ongoing professional development to support teachers. By addressing these gaps, schools can play a pivotal role in preparing children for lifelong health management, reducing the burden on healthcare services, and supporting public health objectives., (© 2024. The Author(s).)

Aim: To examine the range of services pharmacists provide and their impact on patient outcomes, harm reduction, and appropriate opioid use. Methods: Six databases were searched (MEDLINE, EMBASE, Scopus, PsycINFO, CENTRAL and Cochrane Methodology Register) from inception to March 2023. The protocol was registered in PROSPERO (CRD42023401895). Results: Twenty-nine studies identified five key areas of pharmacist interventions in opioid management-naloxone programs and opioid de-escalation, patient and primary healthcare providers' education and motivational interview, prescription monitoring and opioid risk screening, clinical pharmacy interventions (pharmacotherapy, medication review, prescribing, adherence monitoring), and collaborative healthcare approaches to promote optimal opioid use. Outcomes assessment indicated harm reduction, improved safety, increased non-opioid analgesic use, decreased opioid consumption, and enhanced pain management. Conclusion: This review underscores pharmacists' vital role in tackling opioid misuse, overuse and abuse, providing a foundation for evidence-based policies to minimize harm and promote optimal opioid use.

Introduction: There is a paucity of research on and a limited understanding of patient and public involvement (PPI) in the context of research in homelessness and, in particular, direct involvement of people with lived and living experience of homelessness (PEH) as expert advisors. We aim to report on outcomes and reflections from lived experience advisory panel (LEAP) meetings and PPI activities, held throughout the study lifecycle of a pilot randomised-controlled trial (RCT) focused on evaluating integrated health and practical support for PEH., Methods: Community Pharmacy Homeless Outreach Engagement Non-medical Independent prescribing Rx (PHOENIx Community Pharmacy RCT) is an integrated health and social care intervention for people experiencing homelessness who present to community pharmacy. Intervention includes weekly support from a pharmacist prescriber and a third sector support worker for up to 6 months. PPI activities undertaken throughout the study were documented, including outcomes of LEAP meetings. Outcome reporting followed Guidance for Reporting Involvement of Patients and the Public 2 Short Form (GRIPP2-SF)., Results: In total, 17 members were recruited into the LEAP; six meetings (three in two study sites) were held. PPI input was also received through representation from homelessness third sector organisation staff as study co-applicants and core membership in the trial steering committee. Together, the PPI activities helped shape the study proposal, design of study materials, data analysis and dissemination materials. LEAP panel members offered valuable input via their experience and expertise into the delivery and refinement of interventions. Although longitudinal input was received from some LEAP members, ensuring repeat attendance in the pre-planned meetings was challenging., Conclusion: People who face social exclusion and marginalisation can provide highly valuable input as equal partners in co-design and delivery of interventions seeking to improve their health and well-being. Fluid membership and flexible methods of seeking and incorporating advice can offer pragmatic approaches to minimising barriers to continued involvement in research., Patient or Public Contribution: This study reports findings and learning relevant to involvement of people with lived and living experience of homelessness as advisors in a research study. It is important for researchers to offer fluid memberships and use diverse methods to receive input from lived experience members, as traditional PPI methodology may be insufficient to ensure inclusivity. Staff and volunteers from third sector organisations were important PPI partners who bring their experience based on frontline service provision, often as the first port of call for people experiencing severe and multiple disadvantage., Trial Registration: ISRCTN88146807., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

Introduction: Pain is the most common complaint among cancer patients, significantly impairing their health-related quality of life (HRQOL). There is limited evidence on the characteristics of pain among cancer patients in Nepal with low-resource settings., Objectives: The primary objective of this study was to evaluate the clinical characteristics of pain, factors influencing pain intensity, and the association of pain severity with quality of life (QoL) among cancer patients. Secondary objectives included investigating perceived barriers to pain management and medication adherence among these patients., Methods: This multi-center, cross-sectional study enrolled adult patients (over 18 years old) with reported cancer diagnoses experiencing pain. Socio-demographic characteristics (e.g., age, gender, educational status), clinical characteristics (e.g. cancer diagnosis, staging), and pain characteristics (e.g., duration, type, location, medicines used for pain management, etc.) were recorded. Outcomes were assessed using the Numeric rating scale (NRS), Pain management Index, European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire, Barriers Questionnaire II, Medication Adherence Rating Scale, and Hospital Anxiety and Depression Scale., Results: Four hundred and eight patients participated in the study. The mean ± SD age was 54.87 ± 15.65, with 226 patients (55.4%) being female. The most common cancer diagnoses were cervical (17.6%), lung (11.8%), and colon/rectum (12.0%) cancers. The most common pain locations were the head and neck (27.0%); a majority (55.6%) reported pain duration of more than 3 months. Nociceptive pain was reported by 42.4% of patients; the mean ± SD of NRS was 4.31 ± 2.69, with 32.4% of patients experiencing moderate pain. Patients with mixed pain type (B = 1.458, p < 0.001) or pain in multiple sites (B = 1.175, p < 0.001), lower Karnofsky Performance Status (KPS) (B = -1.308, p < 0.001), and specific cancer diagnoses such as prostate (B = -2.045, p = 0.002), pancreatic (B = 1.852, p = 0.004), oesophageal (B = 1.674, p = 0.012), and ovarian cancer (B = 1.967, p = 0.047), experienced varying degrees of increased NRS score. The combined chemotherapy and radiotherapy treatment modality was associated with a lower NRS score (B = -0.583, p = 0.017). A significant inverse relationship was observed between pain severity and global health status/QoL (B = -37.36, p < 0.001. Key barriers to pain management included moderate perceptions of physiological effects, communication issues between doctors and patients, and concerns about the harmful effects of pain medicine. The prevalence of non-adherence to pain medications was 13.97%., Conclusion: In conclusion, this study highlights the multi-faceted nature of pain management and QoL for cancer patients in Nepal with low-resource settings. These findings underscore the multifactorial nature of pain perception in cancer patients, with mixed pain types, pain in multiple sites, lower KPS, and specific cancer diagnoses, all contributing significantly to pain severity. Additionally, pain severity was associated with declining QoL. These findings contribute valuable insights into the complex aspects of cancer pain and its broader implications for the well-being of patients, offering a foundation for targeted interventions and improved pain management strategies in the context of cancer care in low-resource settings., (© 2024. The Author(s).)

Background: Pharmacy professionals, given their health expertise, can play a role in enhancing health education within their communities and among patients. The potential of the pharmacy workforce to enhance health education among primary school children is underexplored., Aim: This study aimed to investigate the perspectives of pharmacy staff on the provision of education regarding self-care and treatment of minor ailments to primary school-aged children and to identify roles that pharmacists could play in this regard., Method: Qualitative semi-structured interviews were conducted online with frontline pharmacy staff in the UK who had patient facing roles with primary school-aged children and parents. Interviews were audio-recorded and transcribed verbatim. Thematic data analysis was applied to the transcripts., Results: A total of 17 participants were recruited. Participants included 12 pharmacists, two pharmacy technicians and three pharmacy dispensers. All participants worked within community, hospital or primary care facilities. Five themes emerged from the data analysis: sources of health knowledge accessed by children and parents; a perceived lack of knowledge regarding self-care and treatments for minor ailments among children and parents; a perceived positive impact of education on self-care; barriers to health education; and the potential role of pharmacy staff in self-care education in schools., Conclusion: Pharmacy staff recognise the value of integrating health education into primary school curricula. A collaborative approach with educational institutions could bridge the gap in knowledge regarding self-care and treatment of minor ailments, and could empower children and reduce unnecessary use of healthcare resources., (© 2024. The Author(s).)

This study was aimed to evaluate the impact of community pharmacy (CP)-based medication therapy management (MTM) program on clinical and humanistic outcomes in patients with uncontrolled diabetes. An open label, parallel-group randomised controlled trial was undertaken at a community pharmacy in Riyadh city, Kingdom of Saudi Arabia. Patients with a diagnosis of uncontrolled diabetes (HbA1c of ≥ 8%) meeting the eligibility criteria were randomised to receive either the MTM programme provided by pharmacists or standard care. The primary outcome was change in HbA1c over 6 months. Secondary outcomes included: changes in clinical parameters (blood pressure (BP), lipid profile, serum creatinine (SCr) and albumin-to- creatinine ratio (ACR)), types of drug-related problems (DRPs), health service utilization (HSU), adherence, diabetes distress and overall patient satisfaction with the service at 6-month. A sufficiently powered sample of 160 participants with a mean age was 50 years (SD ± 11.9) was recruited. The majority of the patients (68.1%) were male and had diabetes for more than eight years [IQR 3, 14]. After adjusting for baseline HbA1c, compared to the control group, the mean HbA1c level was 0.02% (p = 0.929) and 0.2% (p = 0.47) lower in the intervention arm at 3-month and 6-month respectively. However, these differences were not statistically significant. Nonetheless, within each arm, there was a significant improvement in HbA1c from baseline. Furthermore, the intervention arm demonstrated improvement in BP control (SBP lowered by 3.2 mmHg (p = 0.05) and DBP lowered by 3.8 mmHg (p = 0.008)). During the study period, none of the participants in the intervention group reported hospitalization or ER visits compared to 14 patients in the control group [OR 0.069 (95% CI 0.004, 1.3)]. Patient satisfaction as measured by Patient Satisfaction with Pharmacist Services Questionnaire 2.0 (PSPSQ 2.0) was significantly higher among MTM program participants compared to standard care (p = 0.00001). Patients in the MTM program were eight times more likely to be adherent compared to the patients in the standard care [OR 7.89 (95% CI 3.6, 17.4)]. MTM program metrics showed that per patient, the pharmacists spent a median of 35 [IQR 30, 44.5] minutes at the initial visit and 20 [IQR 10, 25] minutes during the 6-month visit. The number of DRPs had significantly dropped in the intervention arm at 3 and 6-month (p = 0.0001). In conclusion, CP-based MTM program can improve health outcomes and prevent hospitalisations in patients with diabetes. These findings support the implementation of CP-based MTM services for patients with diabetes in the Kingdom of Saudi Arabia., (© 2024. The Author(s).)

Background: Understanding patient satisfaction is key to advancing pharmacy services and improving health outcomes. There is a lack of a translated and psychometrically validated tool in the Arabic language to measure patient satisfaction with pharmacy services., Objective: To translate the English version of the PSPSQ 2.0 into Arabic language, culturally adapt, and verify its reliability and validity., Setting: A community pharmacy in Riyadh, Saudi Arabia., Method: A cross-sectional study was conducted between April 2021 and June 2022 among patients with diabetes attending a community pharmacy. The International Society for Pharmacoeconomics and Outcomes Research good practice guidelines for linguistic translation and cultural adaptation were used to translate and culturally adapt the English version of PSPSQ 2.0 into Arabic. The Arabic version of PSPSQ 2.0 was subjected to factor analysis using principal component analysis with varimax rotation to evaluate its validity and Cronbach's alpha was used to assess the reliability of PSPSQ 2.0., Results: A total of 129 (68.2% male, and mean age 50 (SD: 11.9) years) patients with diabetes participated in the study. The analysis was undertaken for the items in each of the three domains of PSPSQ 2.0: quality of care, interprofessional relationship and overall care. Exploratory factor analysis revealed validity of 92.7%, 80.5% and 96.2%, respectively. The Arabic version of PSPSQ 2.0 had high internal consistency with Cronbach's alpha scores 0.99, 0.95 and 0.98 for the three measured domains, respectively. The sample adequacy was 0.924., Conclusion: The PSPSQ 2.0 was successfully translated and culturally adapted into the Arabic language and had acceptable validity and reliability to measure patient satisfaction with services provided by pharmacists in community pharmacies., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Albabtain et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The increased utilization of opioids in low- and middle-income countries (LMICs) presents a growing threat of opioid-related abuse, misuse and diversion. Pharmacists, as integral members of healthcare teams, are responsible for dispensing and monitoring opioid use and hold a pivotal role in opioid stewardship within LMICs. This commentary describes the potential and multifaceted roles of pharmacists in opioid stewardship in resource-constrained settings and highlights appropriate strategies for promoting responsible opioid utilization. Opioid stewardship involves prioritising evidence-based prescribing, management and practices for pain management. It includes measures such as incorporating prescription drug monitoring programmes for appropriate opioid prescription, implementing safe disposal through drug take-back programmes, promoting non-opioid pain management, addressing the opioid addiction stigma, tapering opioid dose, educating patients and caregivers, establishing drug information centers, providing rehabilitative services and integrating collaboration with communities and experts. The combined difficulties of restricted access to healthcare resources and services coupled with low levels of literacy worsen the susceptibility to opioid abuse, misuse, and diversion in LMICs. Early detection, assessment and implementation of interventions to optimise opioid use are imperative for ensuring safe and effective opioid utilization, thereby mitigating the risks of overdose and addiction. The involvement of pharmacists in promoting safe and effective opioid utilization through education, monitoring, collaboration, and policy advocacy serves as a critical component in bridging existing gaps in opioid stewardship within LMICs., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Introduction: Pain is a significant healthcare challenge, impacting millions worldwide. Pharmacists have increasingly taken on expanded roles in managing pain, particularly in primary and ambulatory care contexts. This umbrella review aims to systematically evaluate evidence from published systematic reviews that explore the impact of pharmacist-delivered interventions on clinical, humanistic, and economic outcomes related to pain., Methods: A systematic search was conducted across six electronic databases, including Ovid Embase, MEDLINE, CINAHL, Scopus, CENTRAL, APA PsycINFO, and DARE, from inception until June 2023. Prior to inclusion, two independent reviewers assessed study titles and abstracts. Following inclusion, an assessment of the methodological quality of the included studies was conducted. AMSTAR 2 was used to evaluate the methodological quality of the included SRs., Results: From 2055 retrieved titles, 11 systematic reviews were included, with 5 out of 11 being meta-analyses. These SRs encompassed diverse pharmacist-led interventions such as education, medication reviews, and multi-component strategies targeting various facets of pain management. These findings showed favorable clinical outcomes, including reduced pain intensity, improved medication management, enhanced overall physical and mental well-being, and reduced hospitalization durations. Significant pain intensity reductions were found due to pharmacists' interventions, with standardized mean differences (SMDs) ranging from -0.76 to -0.22 across different studies and subgroups. Physical functioning improvements were observed, with SMDs ranging from -0.38 to 1.03. Positive humanistic outcomes were also reported, such as increased healthcare provider confidence, patient satisfaction, and quality of life (QoL). QoL improvements were reported, with SMDs ranging from 0.29 to 1.03. Three systematic reviews examined pharmacist interventions' impact on pain-related economic outcomes, highlighting varying cost implications and the need for robust research methodologies to capture costs and benefits., Conclusion: This umbrella review highlights the effectiveness of pharmacist-delivered interventions in improving clinical, humanistic, and economic outcomes related to pain management. Existing evidence emphasises on the need to integrate pharamacists into multi-disciplinary pain management teams. Further research is needed to investigate innovative care models, such as pharmacist-independent prescribing initiatives within collaborative pain management clinics., Competing Interests: Declaration of competing interest The authors declare that during the registration of this umbrella review in PROSPERO, it was indicated that the findings from the included studies would be reported following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. However, once the review commenced, it was determined that the Preferred Reporting Items for Overviews of Reviews (PRIOR) would be more suitable for guiding umbrella reviews. This change in reporting guidelines may have influenced the review process and interpretation of the results. Additionally, some findings of this umbrella review were presented at the First Conference of the ISPOR Student Network Asia-Pacific Region on February 16–17, 2024. Apart from these, the authors have no competing interest to declare., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Pharmacy practice research often focuses on the design, implementation and evaluation of pharmacy services and interventions. The use of behavioural theory in intervention research allows understanding of interventions' mechanisms of action and are more likely to result in effective and sustained interventions., Aim: To collate, summarise and categorise the reported behavioural frameworks, models and theories used in pharmacy practice research., Method: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and EBSCO (CINAHL PLUS, British Education index, ERIC) were systematically searched to capture all pharmacy practice articles that had reported the use of behavioural frameworks, theories, or models since inception of the database. Results were filtered to include articles published in English in pharmacy practice journals. Full-text screening and data extraction were independently performed by two reviewers. A narrative synthesis of the data was adopted. Studies were reviewed for alignment to the UK Medical Research Council (MRC) framework to identify in which phase(s) of the research that the theory/model/framework had been employed., Results: Fifty articles met the inclusion criteria; a trend indicating an increasing frequency of behavioural theory/frameworks/models within pharmacy practice research was identified; the most frequently reported were Theory of Planned Behaviour and Theoretical Domains Framework. Few studies provided explicit and comprehensive justification for adopting a specific theory/model/framework and description of how it underpinned the research was lacking. The majority were investigations exploring determinants of behaviours, or facilitators and barriers to implementing or delivering a wide range of pharmacy services and initiatives within a variety of clinical settings (aligned to Phase 1 UK MRC framework)., Conclusion: This review serves as a useful resource for future researchers to inform their investigations. Greater emphasis to adopt a systematic approach in the reporting of the use of behavioural theories/models/frameworks will benefit pharmacy practice research and will support researchers in utilizing behavioural theories/models/framework in aspects of pharmacy practice research beyond intervention development., (© 2023. The Author(s).)

Ensuring access to essential medicines remains a formidable challenge in Nepal. The specific reasons for the shortage of essential medicines within Nepal have not been extensively investigated. This study addresses challenges associated with access to essential medicines, procurement process difficulties, and functionality of inventory management systems at different levels of public health facilities. Fifty-nine semi-structured in-depth interviews were conducted with health managers and service providers at provincial and local levels in six randomly selected districts of Bagmati province, Nepal. Interviews were audiotaped and transcribed verbatim, and the results were analyzed using the inductive approach and were later mapped within the four domains of "Procurement of essential medicines". The major barriers for the effective management of essential medicines included delays in the procurement process, primarily locally, leading to frequent stock-out of essential drugs, particularly at the health post level. Additionally, challenges arise from storage problems, mainly due to insufficient storage space and the need to manage additional comorbidities related to COVID-19. Other identified challenges encompass the absence of training on logistics management information systems, a lack of information technology resources in primary health facilities, inadequate qualified human resources to operate the IT system, and insufficient power backup. Moreover, unrealistic demand estimation from the service points, inadequate transportation costs, and manual inventory management systems further contributed to the complex landscape of challenges. This study identified procurement delays as the primary cause of essential medicine shortages in Bagmati Province, Nepal. We recommend implementing comprehensive procurement guidelines, collaborative training, and dedicated budgets to address this issue. Improving the procurement and inventory management process in low-resource settings requires a well-trained workforce, suitable storage spaces, and enhanced coordinated administrative tiers within health facilities at different levels to ensure the year-round availability of essential medicines in these settings., Competing Interests: No, (Copyright: © 2024 Adhikari et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Antimicrobial resistance (AMR) is widely regarded as an increasing threat to global public health. Antibiotic treatment guidelines have been increasingly recognized as an effective tool to guide appropriate prescriptions and help curtail antibiotic resistance. The present study aimed to assess physician's adherence to hospital antibiotic treatment guideline recommendations in Nepal and determine predictive variables with a significant association. This was a retrospective, monocentric observational review to investigate the adherence to endorsed guidelines using the medical records of adults admitted to the hospital with a diagnosis of urinary tract infection (UTI), pneumonia, or skin and soft tissue infection (SSTI) from January 2018 to December 2019. Of the 2,077 medical records that were reviewed (954 UTI, 754 pneumonia, and 369 SSTI), 354 (17%) met the study inclusion criteria, which included 87 UTI, 180 pneumonia, and 87 SSTI patients. Among eligible patients with antibiotic prescriptions, the following were adherent to guideline recommendations: 33 (37.9%) UTI, 78 (43.3%) pneumonia, and 23 (26.4%) SSTI. The overall extent of adherence to hospital antibiotic treatment guidelines for the use of antibiotics among adult inpatients diagnosed with these common infections was 37.9%. Patients who received ceftriaxone (OR = 2.09, 95% CI = 1.18-3.71, p =0.012) and levofloxacin (OR = 4.63, 95% CI = 1.30-16.53, p =0.018) had significantly higher adherence to treatment guidelines. This study revealed a low adherence rate despite the availability of updated guidelines for antibiotic prescriptions. The findings confer an urgent need to confront antibiotic prescription patterns in such tertiary care centers for tailored interventions to improve adherence to antibiotic guidelines., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2024 Suman Pant et al.)

Publishing in reputable peer-reviewed journals is an integral step of the clinical pharmacy research process, allowing for knowledge transfer and advancement in clinical pharmacy practice. Writing a manuscript for publication in a journal requires several careful considerations to ensure that research findings are communicated to the satisfaction of editors and reviewers, and effectively to the readers. This commentary provides a summary of the main points to consider, outlining how to: (1) select a suitable journal, (2) tailor the manuscript for the journal readership, (3) organise the content of the manuscript in line with the journal's guidelines, and (4) manage feedback from the peer review process. This commentary reviews the steps of the writing process, identifies common pitfalls, and proposes ways to overcome them. It aims to assist both novice and established researchers in the field of clinical pharmacy to enhance the quality of writing in a research paper to maximise impact., (© 2024. The Author(s).)

Background: Recent estimates indicate that a significant proportion of diabetic patients globally, up to 51%, are utilizing complementary and alternative medicine (CAM). To improve patient-provider communication and optimize prescribed treatments, healthcare professionals (HCPs) must understand the factors associated with CAM use among diabetic patients. There is a dearth of literature on HCPs perspectives on CAM use by diabetic patients. This study explored HCPs knowledge, perspective, and views on their diabetic patients' use of CAM., Methods: Qualitative study using one-to-one semi-structured interviews conducted with 22 HCPs involved in the care of diabetic patients (6 endocrinologists, 4 general practitioners, 4 nurses and 8 pharmacists). Participants were recruited through general practices, community pharmacies and a diabetic centre in Saudi Arabia. Data were analyzed using thematic analysis., Results: Five key themes resulted from the analysis. HCPs generally demonstrated negative perceptions toward CAM, particularly regarding their evidence-based effectiveness and safety. Participants described having limited interactions with diabetic patients regarding CAM use due to HCPs' lack of knowledge about CAM, limited consultation time and strict consultation protocols. Participants perceived convenience as the reason why patients use CAM. They believed many users lacked patience with prescribed medications to deliver favourable clinical outcomes and resorted to CAM use., Conclusions: HCPs have noted inadequate engagement with diabetic patients regarding CAM due to a lack of knowledge and resources. To ensure the safe use of CAM in diabetes and optimize prescribed treatment outcomes, one must address the communication gap by implementing a flexible consultation protocol and duration. Additionally, culturally sensitive, and evidence-based information should be available to HCPs and diabetic patients., (© 2024. The Author(s).)