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Copyright of Journal of Faculty of Pharmacy of Ankara University / Ankara Üniversitesi Eczacilik Fakültesi Dergisi is the property of Ankara University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Integrated pharmacist care into health systems results in significant A1c reduction and improved outcomes in patients with diabetes. However, little is known about the adoption of Health System Specialty Pharmacy (HSSP) chronic disease management (CDM) services within diabetes clinics. Risk stratification is proven to enhance care in various patient populations. Objective: The objective of this study is to describe how the implementation of risk stratification in the HSSP setting results in optimized patient outcomes in diabetes. Method: This is a retrospective descriptive study reporting the results of expanding the HSSP care model to implement risk stratified CDM services for patients with diabetes. A total of 285 patients were enrolled in the HSSP CDM pharmacy services and were stratified into high- or low-risk groups. Results: Eighty-eight patients were stratified as high-risk with an average baseline A1c of 11.47% and a most recent average of 8.84%. The remaining 285 patients were stratified into the low-risk group. Their average baseline A1c was 7.48% and the last recorded average A1c was 7.15%. Patients not enrolled in HSSP CDM services (N = 100) had a lower reduction in average A1c compared to patients enrolled in the program. Conclusion: Patients stratified into high- and low-risk groups had greater reductions in A1c compared to patients who did not use HSSP CDM services. These results showcase the success of risk stratification and demonstrate the impact HSSP has on patients needing CDM services and outlines a strategy to provide the greatest impact in a high-volume patient population. [ABSTRACT FROM AUTHOR]

Purpose Illness perception (IP) significantly determines illness outcomes. This study determined the impact of a pharmacist educational intervention on IP and the predictors of IP in patients with prostate cancer (PCa). Methods Using a brief IP questionnaire, an interventional study of patients with PCa was conducted in all cancer reference hospitals in one Nigerian state. After a pre-post assessment of patients' IP, descriptive and inferential statistical analyses were performed. The impact of pharmacists' intervention on IP was determined by paired-sample statistics and correlation analysis at the 95% CI. Relationships and predictors of IP were determined using Kendall's tau-b (τb), likelihood ratio, and F tests of equality of means, respectively. P < 0.05 was considered statistically significant. Results Pharmacists' educational intervention significantly improved IP (SEM, 0.13; r = 0.875; P < 0.0001) among the 200 participants. The analyses also showed a significant paired sample difference (2.662; SEM, 0.06; 95%CI, 2.536-2.788; t = 41.69; df = 199; P < 0.0001). All subscales of patients' IP significantly improved except for illness consequences (P = 0.173) and identity (mean [SD], 4.40 [3.730] in both pre- and postintervention assessments). Pre- and postintervention assessments showed a significant negative relationship of IP with age (τb = –110 [ P = 0.040] and τb = –14 [ P = 0.021], respectively), Gleason score (τb = –0.125 [ P = 0.021] and τb = –0.124 [ P =0.012], respectively), and age at diagnosis (τb = –0.103 [ P = 0.036] post intervention). IP was significantly dependent on the drug therapy (df = 8; mean square [M] = 6.292; F = 2.825; P = 0.006), alcohol intake (df = 1; M = 9.608; F = 4.082; P = 0.045) and Gleason score (df = 9; M = 6.706; F = 3.068; P = 0.002). Conclusion Patients' IP significantly improved after pharmacists' educational intervention. Predictors of IP were drug therapies, alcohol use and Gleason score. Findings can be extrapolated in clinical settings to improve treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: Prescribing errors (PEs) cause significant avoidable harm globally. In Malaysia, despite the prevalence of PEs in government healthcare facilities, there is limited research on how pharmacist staffing levels influence intervention frequency and effectiveness. This study aims to address this gap by analysing intervention trends and assessing their association with staffing levels, highlighting the correlation between increased pharmacist presence and the frequency of interventions. Methods: This retrospective cross-sectional study analysed data from the Ministry of Health's Pharmacy Management Form and the Pharmacy Board Registry from 2017 to 2019. Multivariate regression and two-way ANOVA assessed the association between the number of pharmacists, total prescriptions, and interventions on PEs in Health Clinic Outpatient Pharmacy, Hospital Outpatient Pharmacy, and Hospital Inpatient Pharmacy settings. Results: Annually, pharmacists intervened in approximately 1.8% of total prescriptions, with the most common errors being wrong dose, wrong medication, and wrong dosing frequency. These interventions were consistent across all settings, highlighting the uniformity in pharmacists' approach to managing PEs. The regression analysis revealed a significant positive correlation between the number of pharmacists, total prescriptions, and interventions on PEs, with an adjusted R-squared value of 0.899. Both the number of pharmacists and total prescriptions received were positively significant (p < 0.05), indicating that increased pharmacist presence strongly correlates with intervention frequency. No statistically significant differences were observed in intervention rates across different settings and severity levels, suggesting that pharmacists consistently provide effective interventions irrespective of the clinical context. Conclusion: In conclusion, this study confirms that increasing the number of pharmacists and total prescriptions received are critical predictors of interventions on PEs in Malaysia. It underscores the vital role of pharmacists in enhancing patient safety and healthcare quality, demonstrating their effectiveness in diverse settings and their adaptability to various patient needs and challenges. [ABSTRACT FROM AUTHOR]

Background: Following the Chinese guidelines' recommendation to completely cancel routine cephalosporin skin tests, the choice of cephalosporin as surgical prophylactic medication was affected. This was due to the limited cognition of the predictive value of cephalosporin skin test or the desire to avoid medical disputes. The aim of this retrospective study was to evaluate whether the pharmacist-led perioperative antibiotic prophylaxis model could improve clinicians' medical behavior in choosing cephalosporin antibiotics for surgical prophylaxis. Methods: From July 2021 to May 2022, a retrospective analysis was conducted on the selection of surgical preventive medication, skin test, postoperative infection and adverse drug reactions in foot and ankle surgery. The study was divided into three period: the rountine cephalosporin skin test period (Period I: Skin Test), the period when the routine cephalosporin skin test was cancelled but the pharmacist did not intervene (Period II: Cancel Skin Test), and the period when the pharmacist-led perioperative antibiotic prophylaxis was implemented after the cancellation of the cephalosporin skin test (Period III: Pharmacist Intervention). Results: A total of 1,583 patients were enrolled in this study. There was no significant difference in the utilization rate of cefuroxime between the routine skin test stage and the skin test cancelled stage [74.92% (Period I) vs. 74.54% (Period II), P > 0.05]. However, in the pharmacist intervention stage, the usage rate of cefuroxime significantly increased compared to the initial stage when the skin test was cancelled [87.07% (Period III) vs. 74.54% (Period II), P < 0.05]. The use of cephalosporins also increased in patients with self-reported beta-lactam allergies between these stages [41.94% (Period III) vs. 3.22% (Period II), P < 0.05)]. There was no significant difference in the incidence of postoperative infection and adverse drug reactions among the three periods. Conclusion: The pharmacist-led perioperative antibiotic prophylaxis model can significantly improve the medical behavior of clinicians in choosing cephalosporin antibiotics as surgical prophylactic medication and optimize the perioperative medication plan. [ABSTRACT FROM AUTHOR]

BACKGROUND: Irrational pharmacotherapy and increasing pharmacy costs remain major concerns in healthcare systems. Pharmacists are expected to employ diagnosis-related group (DRG) data to analyse inpatient pharmacy utilization. OBJECTIVE: This project aimed to pilot an efficient pharmacist-led programme to analyse factors related to pharmacy expenses, evaluate the rational use of drugs in batch processing, and make further interventions based on DRG data. METHODS: Patients from the OB25 (caesarean section without comorbidities or complications) DRG were selected in 2018, and the most relevant factors were identified through statistical analysis. Interventions were implemented by sending monthly reports on prescribing data and drug review results for the same DRGs to the department starting in 2019. Pre–post comparisons were conducted to demonstrate changes in pharmacy costs and appropriateness at a tertiary teaching hospital with 2,300 beds in China. RESULTS: A total of 1,110 patients were identified from the OB25 DRG data in 2018. Multivariate linear analysis indicated that the number of items prescribed and wards substantially influenced pharmacy expenditure. Drugs labelled as vital, essential, and non-essential revealed that 46.6% of total pharmacy costs were spent on non-essential drugs, whereas 38.7% were spent on vital drugs. The use of inappropriate pharmaceuticals and drug items was substantially reduced, and the average pharmacy cost after intervention was 336.7 RMB in 2020. The benefit–cost ratio of the programme was 9.86. CONCLUSION: Interventions based on DRG data are highly efficient and feasible for reducing inpatient pharmacy costs and non-essential drug use. [ABSTRACT FROM AUTHOR]

Pharmacists are ideally situated and trained to educate and advocate for the proper use of inhaled medications among patients in the community. Proper inhaler technique is an important way to prevent exacerbations and manage the symptoms associated with chronic pulmonary diseases. The American Lung Association estimates almost 6 million people 65 years of age or older had a diagnosis of chronic obstructive pulmonary disease (COPD) in 2020 in the United States. However, published reports have found that less than 20% of older people with COPD use inhalers correctly. As inhalers are the primary route of administration for medications used to treat chronic airway diseases such as COPD, pharmacist-led education can help overcome the widespread lack of knowledge regarding proper inhaler use. [ABSTRACT FROM AUTHOR]

Introduction: Outpatient oncology practice is a growing area of opportunity for pharmacists to provide clinical services and evidence-based care. Methods: This single-center, retrospective chart review analyzed the clinical and economic benefits of a board-certified oncology pharmacist after integration into the ambulatory oncology clinic setting. Primary outcomes were total cost avoidance for pharmacist interventions and impact on Centers for Medicare and Medicaid Services (CMS) OP-35 measures. Pharmacist interventions were characterized into distinct types which were then assigned a cost avoidance value. Cost avoidance was calculated per hour and then extrapolated to a yearly estimate based on a 40-h work week for one year for one full-time equivalent pharmacist. Data collection for the primary clinical outcome was performed by compiling provider-specific emergency department (ED) and inpatient admission rates for diagnoses specified in CMS OP-35 measures within 30 days after receiving outpatient chemotherapy. The rates for the data collection period were compared to the rates six months prior to pharmacist integration to assess pharmacist impact. Results: In six months, 516 total interventions were made by the oncology pharmacist. The incidence of ED visits was 3.34% and 1.72% during the pre- and post-pharmacist intervention periods, respectively. The incidence of inpatient admissions was 2.43% and 0.34% pre- and post-pharmacist intervention, respectively. Total cost avoidance was estimated to be US$375,795 and when accounted for the median pharmacist salary at our institution, total cost savings was US$204,437. Conclusion: The presence of an oncology pharmacist specialist in the ambulatory cancer clinic provided clinical and economic benefits to the cancer clinic. [ABSTRACT FROM AUTHOR]

Purpose: To assess the risk factors for antimicrobial resistance (AMR) by examining physician antibiotic prescribing patterns, and patient adherence. Methods: A cross-sectional descriptive study was conducted across two sites. The study involved two components: physician-focused assessment of inappropriate antibiotic prescribing and patient-focused assessment of antibiotic adherence. Data were collected from patient records and structured forms, and were analyzed using descriptive statistics, with chi-square tests for categorical data. Statistical significance was defined as p < 0.05. Results: The physician-focused study revealed that 40.49 % of antibiotic prescriptions had no indication, and 23.93 % involved drug-drug interactions. The risk of AMR due to inappropriate prescribing was 47.75 %, which decreased to 28.83 % following pharmacist intervention (² = 147.61, p < 0.001). In the patient-focused study, 19.52 % of patients were non-adherent to prescribed antibiotics, contributing to an equivalent risk of AMR. A total of 72.67 % of the patients were male, with a mean age of 50.43 years. Most patients (97.5 %) lacked knowledge about AMR. Conclusion: Inappropriate antibiotic prescribing and patient non-adherence are significant contributors to the development of AMR. Interventions by pharmacists significantly reduce the risk of AMR. The study highlights the need for improved antibiotic stewardship, patient education, and adherence to treatment guidelines to mitigate AMR risk. Locally developed guidelines and shorter antibiotic courses may also help address this growing concern. [ABSTRACT FROM AUTHOR]

Objective This study assesses the impact of a structured clinical pharmacist intervention on glycemic control in diabetic patients maintained on intensive insulin therapy attending the internal medicine clinic in a hospital with limited financial resources. Methods A randomized parallel open-label clinical trial design was employed. Ethical approval was obtained from the Egyptian Ministry of Health (MOH) ethics committee. Adult diabetic patients, on intensive insulin therapy, were recruited from an internal medicine clinic at an MOH hospital. Patients were randomly allocated into two groups; control, on premixed insulin twice daily, and intervention, receiving a structured pharmacist intervention including the addition of regular insulin doses as needed. Patients were followed up for three months. A 1% reduction of HbA1c level at the conclusion was considered the primary outcome. Key findings One hundred and twenty-five patients (62 control and 63 intervention) consented to participate in the study, of whom 98 (46 control and 52 intervention) completed the follow-up period. At three months, the odds ratio for HbA1c reduction by at least by 1% in the intervention group was 3.2 (95% CI 1.45–7.08). Very few cases of hypoglycemia were reported in either group. The HbA1c reduction was not affected by age, weight, or literacy status of the patients. Conclusions Clinical pharmacist interventions, even in environments with scarce resources and socioeconomic challenges, remain effective in achieving better glycemic control. This trial has been registered in the Pan-African Clinical Trial Registry (PACTR201610001812290, https://pactr.samrc.ac.za/). [ABSTRACT FROM AUTHOR]

Background: The value of clinical pharmacists for ambulatory internal medicine clinics is well recognized, including their role in hemoglobin A1c (HbA1c) reduction in patients with type 2 diabetes mellitus (T2DM). However, there is a lack of data evaluating the clinical impact of remote, referral-based pharmacy programs. Methods: This multicenter, cohort, retrospective chart review study analyzed the impact of pharmacist interventions on blood glucose control in patients aged 18 years and older who were diagnosed with T2DM with an HbA1c of 8.5% or greater and referred to the clinical pharmacy team for medication evaluation. Primary care providers may have accepted or rejected pharmacist recommendations. The primary study outcome was the mean change in HbA1c from baseline to follow-up at 2 to 5 months. Secondary outcomes included appropriate use of American Diabetes Association–indicated secondary prevention and any occurrence of glycemia-related events (i.e., T2DM-related emergency room visits or hospitalizations). Results: At the conclusion of the study, the mean change in HbA1c from baseline to follow-up at 2 to 5 months was −2.7% and −0.6% for the accepted and rejected intervention groups, respectively (t = −2.94, P = 0.0068). Conclusions: The results of this study suggest that remote pharmacist intervention significantly improves blood glucose control in adults with T2DM. [ABSTRACT FROM AUTHOR]

Copyright of Folia Pharmaceutica Cassoviensia is the property of University of Veterinary Medicine & Pharmacy in Kosice and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: While public health efforts have made tobacco smoking near obsolete among adolescents, vaping products are quickly taking their place. With the negative health consequences looming ahead of young vapers, there is a desperate need to curb youth vaping. Adolescents want to be actively engaged in their health which creates space to educate on vaping in this population segment. Methods: From January to May 2023, 35 adolescents aged 11–18 participated in interviews to assess the investigator-developed Teen E-cigarette and Vaping Educational Resource (T-EVER). All the interviews were recorded and transcribed for independent analysis by two study team members. Results: The participants liked the T-EVER, indicating they were engaged in the content. However, some participants wanted more information. The participants wanted health professionals to educate them on vaping but were worried about the potential barriers facing the implementation in community pharmacy settings. Conclusions: Adolescents want to learn about vaping, but there are limited opportunities to do so. The T-EVER is designed to educate youth about vaping. This tool was well received and has the potential to be used by pharmacists as a vaping prevention and cessation intervention. More research is required to discern the true scope of the pharmacist's role in using an educational tool to address adolescent vaping. [ABSTRACT FROM AUTHOR]

Background: Health-related quality of life )HRQOL( is increasingly acknowledged as a significant endpoint in research on the effectiveness of bariatric surgery. Aim of the Study: Assessment of the role of pharmacist educational intervention & training in weight reduction, improvement of dietary practice, and enhancement of HRQOL after bariatric surgery. Patient and Method: A randomized comparative interventional study was conducted in Najaf Governorate, Iraq. The Intervention group included 58 patients who received standard care and training educational and support programs. The standard care group included 58 patients who received standard care after bariatric surgery. The required information included age, gender, practice recommended physical activity, cause and type of surgery. In addition to body mass index, dietary practices, and quality of life (assessed by MOOREHEAD-ARDEL score) were assessed at 3 and 6 months after surgery. Results: There reduction of the body mass index was larger in the intervention than the standard care group at 3 months and 6 months. The overall total mean MOOREHEAD-ARDEL score a significantly higher in the intervention than standard care group at 6 months, (P<0.001). The mean total scores of dietary practices was significantly higher in the intervention group at 6 months compared to the standard care group at 6 months (P-value<0.001). Conclusion: The pharmacist intervention leads to larger weight reduction, better dietary practice, and better quality of life at six months after surgery. [ABSTRACT FROM AUTHOR]

BackgroundFollowing the Chinese guidelines’ recommendation to completely cancel routine cephalosporin skin tests, the choice of cephalosporin as surgical prophylactic medication was affected. This was due to the limited cognition of the predictive value of cephalosporin skin test or the desire to avoid medical disputes. The aim of this retrospective study was to evaluate whether the pharmacist-led perioperative antibiotic prophylaxis model could improve clinicians’ medical behavior in choosing cephalosporin antibiotics for surgical prophylaxis.MethodsFrom July 2021 to May 2022, a retrospective analysis was conducted on the selection of surgical preventive medication, skin test, postoperative infection and adverse drug reactions in foot and ankle surgery. The study was divided into three period: the rountine cephalosporin skin test period (Period I: Skin Test), the period when the routine cephalosporin skin test was cancelled but the pharmacist did not intervene (Period II: Cancel Skin Test), and the period when the pharmacist-led perioperative antibiotic prophylaxis was implemented after the cancellation of the cephalosporin skin test (Period III: Pharmacist Intervention).ResultsA total of 1,583 patients were enrolled in this study. There was no significant difference in the utilization rate of cefuroxime between the routine skin test stage and the skin test cancelled stage [74.92% (Period I) vs. 74.54% (Period II), P > 0.05]. However, in the pharmacist intervention stage, the usage rate of cefuroxime significantly increased compared to the initial stage when the skin test was cancelled [87.07% (Period III) vs. 74.54% (Period II), P < 0.05]. The use of cephalosporins also increased in patients with self-reported beta-lactam allergies between these stages [41.94% (Period III) vs. 3.22% (Period II), P < 0.05)]. There was no significant difference in the incidence of postoperative infection and adverse drug reactions among the three periods.ConclusionThe pharmacist-led perioperative antibiotic prophylaxis model can significantly improve the medical behavior of clinicians in choosing cephalosporin antibiotics as surgical prophylactic medication and optimize the perioperative medication plan.

Abstract Background Pharmaceutical interventions play a key role in the care of older people experiencing polypharmacy. Despite the rapid increase in the aging population in Asia, there is a lack of evidence regarding the effectiveness of pharmacist interventions on older adult’s healthcare. This systematic review and meta-analysis assessed the effects of pharmacist interventions in Asian health care environments on hospitalization, mortality, and quality of life (QoL) among older people in Asia. Methods A comprehensive search was conducted across 5 databases, encompassing studies published from inception through June 2023. Only studies involving pharmacist interventions for people aged 65 years or older, residing in Asian countries, were considered. Studies without evidence of pharmacist involvement or conducted outside of Asia were excluded. Data extraction was performed by two reviewers, one reviewer (I.K.) performed the initial extraction, and another reviewer (G.R.) verified the extracted data. Forest plots were generated using a random effects model to obtain risk ratios or pooled standardized mean differences (SMDs). Results A total of 170 articles underwent thorough review, and ultimately, ten studies meeting the inclusion criteria were included in the meta-analyses. These studies encompassed diverse healthcare settings such as outpatient, inpatient, and nursing homes, with sample sizes ranging from 32 to 306 older people. Pharmacist interventions were found to significantly reduce hospitalization rates (n = 5, risk ratio = 0.57, 95% CI = 0.41–0.81) and mortality rates (n = 4, risk ratio = 0.57, 95% CI = 0.37–0.88) among older people. The analysis revealed less significant improvement in QoL in these patients than in those receiving usual care (n = 6, SMD = 0.36, P = 0.057). Conclusions These findings highlight the crucial role of pharmacists within healthcare teams in Asian countries. Pharmacist interventions have an impact on reducing hospitalization and mortality rates among the elderly people, underscoring the importance of optimizing patient outcomes in Asia.

Introduction: To promote optimal healthcare delivery, safeguarding older adults from the risks associated with inappropriate medication use is paramount. Objective: This study aims to evaluate the effectiveness of implementing the Qatar Tool for Reducing Inappropriate Medication (QTRIM) in ambulatory older adults to enhance medication safety. Method: The QTRIM was developed by an expert consensus panel using the Beers Criteria and contained a list of potentially inappropriate medications (PIMs) based on the local formulary. Using quality improvement methodology, it was piloted and implemented in two outpatient pharmacy settings serving geriatric medicine and dermatology clinics at Rumailah Hospital, Qatar. Key performance indicators (KPIs) using implementation documentation as a process measure and the percentage reduction in PIM prescriptions as an outcome measure were assessed before and after QTRIM implementation. This study was conducted between July 2022 and September 2023. Results: In the outpatient department (OPD) geriatric pharmacy, the prescription rate of PIMs was reduced from an average of 1.2 ± 0.7 PIMs per 1000 orders in 2022 to an average of 0.8 ± 0.2 PIMs per 1000 orders in 2023. In the OPD geriatric pharmacy, the results showed a 66.6% reduction in tricyclic antidepressants (TCAs) (from 30 to 10), a reduction in first-generation antihistamines by 51.7% (29 to 14), and muscle relaxants by 33.3% (36 to 24). While in dermatology, the older adult prescription rate of PIMs was reduced from an average of 8 ± 3 PIMs per 1000 orders in 2022 to a rate of 5 ± 3 PIMs per 1000 orders in 2023; the most PIM reductions were (49.4%) in antihistamines (from 89 to 45), while muscle relaxants and TCAs showed a minimal reduction. Conclusions: Implementing QTRIM with pharmacy documentation monitoring markedly reduced the PIMs dispensed from two specialized outpatient pharmacies serving older adults. It may be a promising effective strategy to enhance medication safety in outpatient pharmacy settings. [ABSTRACT FROM AUTHOR]

Background: Bariatric surgery is the most successful treatment for obesity regarding the degree and duration of weight loss. Aim of the Study: Evaluate the impact of pharmacist educational intervention and training in improving patient adherence and its association with the prevention of clinical nutritional complications after bariatric surgery. Patient and Method: A randomized comparative interventional study was conducted in Najaf Governorate, Iraq. The Intervention group included 58 patients who received standard care and training educational and support programs. The standard care group included 58 patients who received standard care after Bariatric surgery. Results: In the intervention group, at 3 months of follow-up, the mean total score was 5.8 and increased to 6.7 at the 6 months. Conversely, the score decreased in the standard care group from 5.3 at 3 months to 2.2 at 6 months. In contrast to the standard care group, an inverse significant correlation was found between the number of incident complications and the total eight-item Morisky Medication Adherence Scale (MMAS-8) at 3 and 6 months in the intervention group. Conclusion: The pharmacist intervention leads to better patient adherence to gulidline after Bariatric surgery which results in decreased complications at three and six months after surgery. [ABSTRACT FROM AUTHOR]

Background: Due to the addition of multiple new medicines following an acute myocardial infarction (MI), medication non-adherence occurs frequently. Medication education can improve adherence, comprehension, and health-related outcomes. There is currently limited literature about individualised pharmacist-led medication education post-hospital discharge following an MI. Aim: To assess whether individualised, pharmacist-led education increased patient adherence and comprehension of cardiovascular medicines over a 12-week period following an MI. Method: All participants completed the Morisky Medication Assessment Scale (MMAS) of self-reported adherence at 1 week and 12 weeks post-hospital discharge. Alongside this, a questionnaire was completed to quantify comprehension of their treatment plan. Participants were randomised to receive individualised pharmacist-led education directed at their medication regimen at 4–6 weeks post-discharge. Data were analysed using paired t-tests and mixed-design analysis of variance (ANOVA). Ethical approval was granted by the Monash Health Human and Research Ethics Committee (Reference no: RES-21-0000234L) and the study conforms to the Australian National Statement on Ethical Conduct in Human Research. Informed consent was obtained from all participants via project information sheets, verbal explanations by recruiting pharmacists with reassurance there would be no difference in standard treatment should patients decline involvement in the project, and written consent forms were completed by all participants. Results: Of the 29 participants, 15 (51%) received pharmacist-led education. The intervention group’s mean MMAS score increased from 6.7 (moderate adherence) at week 1 to 7.6 (moderate adherence) at week 12 post-hospital discharge (p = 0.009). At 12 weeks, the intervention group demonstrated a statistically significant and greater mean MMAS score compared to the control group (7.6 moderate adherence and 6.9 moderate adherence respectively, p = 0.003). The intervention group’s mean comprehension level increased from 58% at 1 week to 90% at 12 weeks (p < 0.05). The intervention group demonstrated a greater mean comprehension level at 12 weeks compared to the control group (90% and 48.21% respectively, p < 0.001). Conclusion: This pilot study demonstrated that individualised, pharmacist-led education may improve self-reported medication adherence and comprehension. [ABSTRACT FROM AUTHOR]

Abstract Objective The purpose of this study was to evaluate the inhaler skills of patients with asthma and chronic obstructive pulmonary disease in a hospital in western China after receiving one medication education by pharmacists and the factors related to these skills. Methods We included 96 subjects using Turbuhaler and 74 subjects using Diskus in a hospital in western China. They were educated once by pharmacists before medication, and then their skills of operating these inhalers were visually evaluated the next time they were used. Using the seven-step inhalation administration method designed by AnnaMurphy, a clinical pharmacist at GLENFIELD Hospital in the UK, the inhaler use technique score scale was established and scored in turn. The age, sex, time of first illness, smoking status, education level and type of health insurance purchased by each patient were recorded to assess their relationship with overall inhaler skills. Results 19.8% of the subjects who used Turbuhaler could not use it correctly, and 43.2% of the subjects who used Diskus could not use it correctly. The step with the highest error rate with Turbuhaler and Diskus is to "exhale slowly to residual volume". Chi-square test was carried out for each step of the operation of the two kinds of inhalers, and it was found that there was a significant difference in the operation accuracy of the two kinds of inhalers in the first, third and eighth steps. In univariate analysis, advanced age, female and low educational level were related to the lack of inhaler technology, but in multivariate analysis, only low educational level was a significant independent risk factor. Conclusion Among the patients with asthma and chronic obstructive pulmonary disease in western China, some patients have good inhaler operation skills, but there are still many patients who can not use inhalers correctly, and the lower education level is significantly related to the incorrect use of inhalers.

This case report describes a pharmacist's intervention with a 58-year-old female who presented with recurrent rhinosinusitis symptoms and limited treatment options due to a complicated allergy history. Using guidelines for treatment of acute bacterial rhinosinusitis coupled with a thorough antibiotic allergy assessment, the pharmacist developed a treatment plan that was acceptable to both the patient and the provider. Pharmacists can play an essential role in verification of allergies to both medications and non-pharmaceutical products, which further ensures patient safety as well as optimization of appropriate treatment methods. [ABSTRACT FROM AUTHOR]

Although prescription review is an important role for pharmacists in anticancer drug therapy, there are no guidelines in Japan that specify what pharmacists should check for in chemotherapy regimens. This prospective multicenter survey aimed to investigate the implementation of chemotherapy regimen checks by pharmacists in general hospitals by focusing on 19 recommended confirmation items designed to enhance chemotherapy safety. This study involved 14 hospitals within the National Hospital Organization in different regions of Japan. The top five cancers in Japan (gastric, colorectal, lung, breast, and gynecological) were targeted and specific chemotherapy regimens were analyzed. This study assessed the amount of time required for regimen checks, the number of confirmation items completed, the number and the content of inquiries raised regarding prescriptions, and the pharmacists' opinions using a questionnaire that had a maximum score of 10 points. Pharmacists checked 345 and 375 chemotherapies of patients in the control group (CG) and recommended items group (RIG), respectively. The mean time periods required for completing a chemotherapy regimen check were 4 min and 14 s (SD ±1 min and 50 s) and 6 min and 18 s (SD, ±1 min and 7 s) in the CG and RIG, respectively. The mean of the recommended items for the CG = 12.4 and for the RIG = 18.6. The items that the pharmacists did not confirm included urine protein (sixty-nine cases, 18.4%), allergy history (four cases, 1%), previous history (two cases, 0.5%), and a previous history of hepatitis B virus (sixty-nine cases, 18.4%). The number of inquiries for a doctor's prescription order was higher in the RIG than in the CG (41 vs. 27 cases). This multicenter survey demonstrated the potential effectiveness of implementing 19 recommended confirmation items in the regimen checks by pharmacists in general hospitals other than cancer treatment collaborative base hospitals. [ABSTRACT FROM AUTHOR]

Objectives: Non-adherence to tuberculosis (TB) treatment is the leading cause of the increase in drug resistance cases. This study will determine the effectiveness of pharmaceutical-care-based interventions coupled with short messages delivered by a pharmacist on treatment outcomes and adherence among TB patients. Methods: The study will be conducted in TB Control Center of Pakistan Institute of Medical Sciences Hospital, Islamabad and District Bannu TB Control Center time period will be from August 2019 to September 2021. The patients will be included into the control group (usual care) or the intervention group pharmaceutical care and SMS reminder. The primary outcome includes a change in mean score from baseline in treatment outcomes and adherence, measured by Morisky Medication Adherence Scale, and clinic appointment attendance registration. Secondary outcomes include health-related quality of life of patients, disease knowledge, and patient satisfaction with the intervention. Result: The major issues in patients with TB are cure rate and medication adherence. The method anticipated in this manuscript could set the foundation of pharmaceutical care and mobile SMS for the future provision of care to improve TB treatment outcomes. Conclusion: The study will make available fundamental information about the influence of the patient centered program on the adherence and clinical outcomes of patients with TB. [ABSTRACT FROM AUTHOR]

Introduction: Pediatric intensive care unit (PICU) patients are constantly exposed to the risk of prescribing errors due to the complexity in drug dosing and administration. Hence, a measure to prevent these unwanted errors is necessary. Objectives: This study aimed to develop, validate and to assess the effectiveness of a drug dosing pocket guide in reducing the frequency of dosing-guide relevant pharmacist interventions in PICU and to explore the satisfaction as well as perception of the doctors. Methods: A drug pocket guide on commonly used drugs in the PICU was developed and validated. Copies of the guide were distributed to practicing doctors in the pediatric department of Hospital Pulau Pinang. The number of PICU ward pharmacist interventions, an indicator of prescribing errors, were collected and compared before and after using the guide. A run chart was plotted to evaluate the effectiveness of the pocket guide. A post-intervention questionnaire was used to gauge doctor satisfaction and perception towards the pocket guide. Results: Pharmacist interventions were reduced from eighteen (9.6%) to seven (3.5%) after introduction of the pocket guide, p=0.51. The run chart signaled a favorable shift below the median (median=5). The questionnaire revealed that 94.4% of the doctors were still using the pocket guide and all of them (n=18) agreed that the guide helped to improve patient safety. Conclusion: A validated drug dosing pocket guide reduced the frequency of pharmacist interventions which was sustained over time. This inexpensive and simple guide was generally well received by the doctors. [ABSTRACT FROM AUTHOR]

Abstract Background Optimised antithrombotic therapy requires clinical experience and an understanding of the current guidelines. This retrospective study aimed to evaluate whether pharmacist interviews and interventions with patients taking oral antithrombotic drugs in the pharmaceutical outpatient cardiology clinic had favourable clinical outcomes including decreased bleeding. Methods The participants included patients visiting the outpatient clinic of cardiovascular internal medicine at the Kobe University Hospital from January–December 2017, and were taking oral antithrombotic medication. The observation period was from the first visit to the outpatient clinic to October 2021 or death. Patients who received pharmacist intervention more than twice were defined as the pharmacist intervention group. Two control patients per one pharmacist intervention group individual were selected from the non-intervention pool matched for age, gender and antithrombotic medication type. Results Of the 895 eligible patients, 132 were in the pharmacist intervention group and 264 were selected for the matched non-intervention group. Bleeding events according to the Bleeding Academic Research Consortium criteria over type 2 were significantly lower in the pharmacist intervention group compared with the non-intervention group (17.4% versus 28.4%, P = 0.019). There were no significant differences in mortality and heart failure hospitalisation frequency, stroke, or cardiovascular events between the groups. Multivariate analysis identified age (≥ 65 years) and pharmacist intervention as factors associated with bleeding (odds ratio = 2.29 and 0.51, respectively). Conclusion Pharmacist intervention in the outpatient clinic of cardiovascular internal medicine was effective in reducing the risk of bleeding in patients undergoing antithrombotic therapy.

Patients with asthma and chronic obstructive pulmonary disease rely on inhaler therapy to reduce disease progression and exacerbation risk. Patients admitted to the hospital are at an increased risk for exacerbations and readmission if their inhaler therapy upon discharge is not aligned with current guidelines and/or affordable. The objective of this study was to assess the appropriateness of the chronic inhaler regimen for patients admitted to the hospital based on clinical practice guidelines and insurance coverage. A sub‐study was designed to analyze a cohort of a single‐center, pragmatic, prospective randomized controlled trial at a large academic medical center. Patients admitted to a medicine service with a pharmacist and prescribed a long‐acting inhaler were included. Participants randomized to a pharmacist‐led intervention were assessed for inhaler appropriateness based on clinical guidelines and patient insurance. The objective of this sub‐study is to assess the number of inhalers identified as inappropriate based on the pharmacist's review. A patient was considered to have an inappropriate inhaler regimen if any of their inhalers were inconsistent with guideline recommendations or not covered by insurance. Descriptive statistics were used to characterize appropriate inhaler use. The study pharmacist reviewed 552 unique inhalers for 348 patients. Overall, 42% of inhalers were inappropriate, affecting 50.3% of participants; 20% of inhalers were inappropriate based on insurance, 26% were inappropriate based on guidelines, and 7% were inappropriate based on both criteria. Recommendations were placed via a pharmacy consult for 198 patients (57%), most recommending an inhaler initiation (55%), followed by inhaler discontinuation (38%). A pharmacist‐led review of chronic inhaler therapy for patients admitted to the hospital identified the need for a change in therapy based on financial or clinical guidelines in over half of the patients reviewed. Interventions to increase the appropriateness of prescribed inhalers are needed to reduce disease progression and disease exacerbation. [ABSTRACT FROM AUTHOR]

Background: A Best Possible Medication History (BPMH) collected by clinical pharmacists is crucial for effective medication review, but, in Italy, it is often left to the nursing staff. This study aims to compare the quality and accuracy of a clinical pharmacist-documented BPMH with the current standard practice of ward staff-collected BPMH in an Italian preoperative surgical setting. Methods: A 20-week prospective observational non-profit study was conducted in a major university hospital. The study comprised three phases: a feasibility, an observational, and an interventional phase. During the feasibility phase, 10 items for obtaining a correct BPMH were identified. The control group consisted of retrospectively analyzed BPMHs collected by the ward staff during the observational phase, while interventions included BPMHs collected by the clinical pharmacist during the third phase. Omissions between the two groups were compared. Results: 14 (2.0%) omissions were found in the intervention group, compared with 400 (57.4%) found in the controls (p < 0.05); data collection was more complete when collected by pharmacists compared to the current modality (98.0% of completed information for the intervention versus 42.6%; p < 0.05). Conclusions: The involvement of a pharmacist significantly reduced the number of omissions in preoperative surgical-collected BPMHs. This intervention holds the potential to decrease the risk of medication errors associated with inaccurate or incomplete BPMHs prior to surgical hospitalization. [ABSTRACT FROM AUTHOR]

Objective: Our initiative aimed to improve the system used to capture pharmacist clinical interventions to better support staff to document, manage and identify trends in medication-related problems (MRPs). The aim of the study was to develop an electronic tool which is easily accessible by most electronic devices with secure data storage and access. Methods: A REDCap® database was designed for documentation of pharmacy clinical interventions. Information documented can be retrieved in real-time and can be integrated to Microsoft Power BI® for real-time data visualisation. The dashboards were customised to display useful information including pharmacy clinical intervention details, common MRPs, common medications involved available to users at real time. Results: A total of 4343 interventions were documented from July 2022 to March 2023. The most common MRPs were omission of regular medications 876 (20.17%), condition untreated 722(16.62%), and contraindications apparent 451 (10.38%). The most common medications involved include iron 244 (5.62%), enoxaparin 231 (5.32%), macrogol laxatives 208 (4.79%), multivitamin 206 (4.74%), colecalciferol 179(4.12%), tramadol 156 (3.59%). Conclusion: This study demonstrated the significance of integration of health application tools of REDcap and Power BI in the data management and intelligent visual analytics and reporting.

Background: Optimised antithrombotic therapy requires clinical experience and an understanding of the current guidelines. This retrospective study aimed to evaluate whether pharmacist interviews and interventions with patients taking oral antithrombotic drugs in the pharmaceutical outpatient cardiology clinic had favourable clinical outcomes including decreased bleeding. Methods: The participants included patients visiting the outpatient clinic of cardiovascular internal medicine at the Kobe University Hospital from January–December 2017, and were taking oral antithrombotic medication. The observation period was from the first visit to the outpatient clinic to October 2021 or death. Patients who received pharmacist intervention more than twice were defined as the pharmacist intervention group. Two control patients per one pharmacist intervention group individual were selected from the non-intervention pool matched for age, gender and antithrombotic medication type. Results: Of the 895 eligible patients, 132 were in the pharmacist intervention group and 264 were selected for the matched non-intervention group. Bleeding events according to the Bleeding Academic Research Consortium criteria over type 2 were significantly lower in the pharmacist intervention group compared with the non-intervention group (17.4% versus 28.4%, P = 0.019). There were no significant differences in mortality and heart failure hospitalisation frequency, stroke, or cardiovascular events between the groups. Multivariate analysis identified age (≥ 65 years) and pharmacist intervention as factors associated with bleeding (odds ratio = 2.29 and 0.51, respectively). Conclusion: Pharmacist intervention in the outpatient clinic of cardiovascular internal medicine was effective in reducing the risk of bleeding in patients undergoing antithrombotic therapy. [ABSTRACT FROM AUTHOR]

Background: Pharmacists are essential team members in critical care and contribute to the safety of pharmacotherapy for this vulnerable group of patients, but little is known about remote pharmacy services in intensive care units (ICU). Aim: We compared the acceptance of pharmacist interventions (PI) in ICU patients working remotely with ward-based service. We evaluated both pharmacy services, including further information on PI, including reasons, actions and impact. Method: Over 5 months, a prospective single-centre observational study divided into two sequential phases (remote and ward-based) was performed on two ICU wards at a university hospital. After a structured medication review, PI identified were addressed to healthcare professionals. For documentation, the national database (ADKA-DokuPIK) was used. Acceptance was used as the primary endpoint. All data were analysed using descriptive methods. Results: In total, 605 PI resulted from 1023 medication reviews. Acceptance was 75% (228/304) for remote and 88% (265/301; p < 0.001) for ward-based services. Non-inferiority was not demonstrated. Most commonly, drug- (44% and 36%) and dose-related (36% and 35%) reasons were documented. Frequently, drugs were stopped/paused (31% and 29%) and dosage changed (31% and 30%). PI were classified as "error, no harm" (National Coordinating Council for Medication Error Reporting and Prevention [NCC MERP] categories B to D; 83% and 81%). The severity and clinical relevance were at least ranked as "significant" (68% and 66%) and at least as "important" for patients (77% and 83%). Conclusion: The way pharmacy services are provided influences the acceptance of PI. Remote pharmacy services may be seen as an addition, but acceptance rates in remote services failed to show non-inferiority. [ABSTRACT FROM AUTHOR]

Objective: This study aims to systematically review the content and potential effects of clinical pharmacy services in tuberculosis (TB) care management. Methods: Searches were performed in PubMed, Embase, Cochrane, Scopus, and Web of Science databases following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Study characteristics and outcomes were extracted, and clinical pharmacy service components were characterized using the Descriptive Elements of Pharmacist Intervention Characterization Tool. Results: Twenty articles were included for full-text assessment, of which 10 fulfilled inclusion criteria, comprising 1,168 patients (N = 39 to 258 per study). These articles included five prospective cohort studies, two case-control studies, two quasi-experimental studies, and one cross-sectional study. Intervention foci within clinical pharmacy services were medication adherence (50%), medication safety (40%), education to patients/caregivers regarding needs/beliefs (30%), optimizing medication/therapy effectiveness (30%), emphasizing HRQoL (10%), and drug selections (10%). The three most frequently applied interventions were drug information/patient counseling (80%), adverse drug reaction monitoring (50%), and drug use evaluation (20%). Based on the World Health Organization (WHO) outcome classification, treatment success ranged from 72% to 93%, with higher cure outcomes (53%-86%) than treatment completion (7%-19%). Other outcomes, including isoniazid metabolites, medication counts, sputum conversion, adherence/compliance, knowledge, and quality of life, were better in the intervention group than those in comparator groups, and/or they improved over time. Risk of bias analysis indicated that the included studies were not comparable to a randomized clinical trial. Conclusion: Clinical pharmacy services as single or composite interventions potentially improve TB outcomes, but its evidence is still inconsistent and limited due to the lack of randomized controlled studies using the WHO outcome classification. [ABSTRACT FROM AUTHOR]

Background: While public health efforts have made tobacco smoking near obsolete among adolescents, vaping products are quickly taking their place. With the negative health consequences looming ahead of young vapers, there is a desperate need to curb youth vaping. Adolescents want to be actively engaged in their health which creates space to educate on vaping in this population segment. Methods: From January to May 2023, 35 adolescents aged 11–18 participated in interviews to assess the investigator-developed Teen E-cigarette and Vaping Educational Resource (T-EVER). All the interviews were recorded and transcribed for independent analysis by two study team members. Results: The participants liked the T-EVER, indicating they were engaged in the content. However, some participants wanted more information. The participants wanted health professionals to educate them on vaping but were worried about the potential barriers facing the implementation in community pharmacy settings. Conclusions: Adolescents want to learn about vaping, but there are limited opportunities to do so. The T-EVER is designed to educate youth about vaping. This tool was well received and has the potential to be used by pharmacists as a vaping prevention and cessation intervention. More research is required to discern the true scope of the pharmacist’s role in using an educational tool to address adolescent vaping.

Abstract Background The number of medications, number of administrations per day, dosing frequency on indicated day, and medication from multiple prescriptions are the medication factors prone to medication errors in self-management that have been previously reported. However, whether pharmacists actually intervene in medication factors that affect medication error occurrences in self-management is unclear. Therefore, we conducted this study to clarify these issues. Method This study included patients who underwent self-management in the rehabilitation ward of Higashinagoya National Hospital. From April 2019 to March 2020, a one-pharmacist period existed, and from April 2020 to March 2021, a two-pharmacist period existed. The number of patient instructions and interventions were expected to increase with an increase in the number of pharmacists. Considering this to be an environment of differential interventions by pharmacists, a pre-post-test design was conducted with all self-managed patients in both the time periods. The primary and secondary endpoints were the proportion of medication error occurrences and proportion of pharmacist’s interventions in medication factors, respectively. Result The proportions of medication error occurrences during the one-pharmacist and two-pharmacist periods were 41% (71/173) and 28% (51/180) (relative risk 0.690, 95% confidential interval 0.515–0.925), respectively. The proportion of pharmacist’s interventions in medication factors in the one-pharmacist period was 13% (22/173) and 22% (40/180) in the two-pharmacist period; there was an increase in the proportion of pharmacist’s interventions in medication factors in the two-pharmacist period. Conclusion The proportion of medication error occurrences was significantly lower in the two-pharmacist period than that in the one-pharmacist period. This can be attributed to the increase in the proportion of pharmacist’s interventions in medication factors. Therefore, an environment in which pharmacists could intervene in the medication factors to prevent medication errors in advance is necessary.

This case report describes the pharmacist intervention with a 62-year-old woman who had postmenopausal breast cancer. The patient was experiencing severe vasomotor symptoms from her cancer therapy and wanted to discontinue her treatment despite her risk of cancer returning. Using guidelines for treatment of postmenopausal breast cancer and medication options to mitigate vasomotor symptoms, the pharmacist developed a treatment plan that was acceptable to the patient and approved by the oncologist. Following implementation, the patient was satisfied to experience minimal hot flashes and relayed full compliance with her breast cancer treatment regimen. Pharmacists can play an important role in the management of postmenopausal breast cancer and vasomotor symptoms by providing patient education and recommending medications based on treatment guidelines with consideration to side effects and drug interactions.

Objective: This study aims to systematically review the content and potential effects of clinical pharmacy services in tuberculosis (TB) care management.Methods: Searches were performed in PubMed, Embase, Cochrane, Scopus, and Web of Science databases following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Study characteristics and outcomes were extracted, and clinical pharmacy service components were characterized using the Descriptive Elements of Pharmacist Intervention Characterization Tool.Results: Twenty articles were included for full-text assessment, of which 10 fulfilled inclusion criteria, comprising 1,168 patients (N = 39 to 258 per study). These articles included five prospective cohort studies, two case–control studies, two quasi-experimental studies, and one cross-sectional study. Intervention foci within clinical pharmacy services were medication adherence (50%), medication safety (40%), education to patients/caregivers regarding needs/beliefs (30%), optimizing medication/therapy effectiveness (30%), emphasizing HRQoL (10%), and drug selections (10%). The three most frequently applied interventions were drug information/patient counseling (80%), adverse drug reaction monitoring (50%), and drug use evaluation (20%). Based on the World Health Organization (WHO) outcome classification, treatment success ranged from 72% to 93%, with higher cure outcomes (53%–86%) than treatment completion (7%–19%). Other outcomes, including isoniazid metabolites, medication counts, sputum conversion, adherence/compliance, knowledge, and quality of life, were better in the intervention group than those in comparator groups, and/or they improved over time. Risk of bias analysis indicated that the included studies were not comparable to a randomized clinical trial.Conclusion: Clinical pharmacy services as single or composite interventions potentially improve TB outcomes, but its evidence is still inconsistent and limited due to the lack of randomized controlled studies using the WHO outcome classification.Systematic review registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=199028, identifier CRD42020199028.

Objectives Clinical pharmacists play an important role in the optimization and individualization of treatment for heart failure patients in the multidisciplinary team. This study aims to demonstrate the impact of pharmacists' interventions on medication adherence and adverse outcomes among heart failure patients. Methods This is a prospective cohort study on 95 chronic heart failure patients in a national hospital of Vietnam. Participants in the intervention group received two consultations with a pharmacist on the third day of admission and one week after discharge while patients in the control group received standard care. The Vietnamese version of the Morisky Medication Adherence Scale-8 was applied to measure the medication adherence at the start of the study, at 2 months and 4 months post-discharge. Adverse outcomes including death and hospital readmissions were also collected during the follow-up period. Key findings Baseline adherence was 53.3% for the intervention group and 58.3% for the control group. After 2 months, 97.7% of the patients in the intervention group were adherent compared to 80.4% in the control group (P < 0.01). The adherent rates in these groups were 90.2% and 71.1% after 4 months, respectively. The intervention group had fewer combined adverse outcomes than their control counterpart, although the difference was not significant (24.4% versus 35.4%, P = 0.249). Conclusions Pharmacist-led interventions improved self-reported medication adherence and might have a positive impact on outcomes among heart failure patients. Patient education and consultations should be a standard of practice to optimize treatment plans among heart failure patients. [ABSTRACT FROM AUTHOR]

Purpose: Oral mucositis is a severe adverse event in patients with head and neck cancer (HNC) receiving chemotherapy and radiotherapy that may cause the termination of cancer treatment. In this study, we aimed to reveal the benefits of pharmacist interventions in oral health care for patients with HNC receiving concurrent chemoradiotherapy (CCRT). Methods: We conducted a multicenter, prospective cohort study on 173 patients from September 2019 to August 2022. We evaluated the association between the occurrence of oral mucositis during CCRT and various factors in the absence or presence of direct medication instructions from hospital pharmacists. Results: Sixty-eight patients received medication instructions from pharmacists (the pharmacist intervention group), whereas 105 patients did not receive instructions (the control group). Logistic regression analysis showed that grade 2 (Gr 2) oral mucositis was significantly lower in patients receiving pharmacist interventions than in patients in the control group (adjusted odds ratio [aOR], 0.42; 95% confidence interval [CI], 0.18–0.96; P = 0.04). The time to onset of Gr 2 oral mucositis was significantly longer in the pharmacist intervention group than in the control group (hazard ratio, 0.53; 95% CI, 0.29–0.97; P = 0.04). Conclusion: Direct intervention, especially when provided by hospital pharmacists, can have a real effect in supporting patients with HNC experiencing severe side effects of treatments. Moreover, the integration of pharmacists into the oral healthcare team is becoming even more essential to reduce the severity of side effects. [ABSTRACT FROM AUTHOR]

Background: Community pharmacists can help fight antimicrobial resistance by intervening in children's antibiotic prescriptions for upper respiratory tract infections (URTIs). However, caregivers' attitudes and perspectives on this are unknown. Objective: To evaluate children's caregivers' acceptability of pharmacists intervening in their antibiotic prescriptions for URTIs with respect to their knowledge of and attitude toward pharmacists and knowledge, beliefs, and behaviors related to antibiotics. Methods: A 69-item survey was created and sent to a panel of caregivers. ANCOVA and path analysis were used to evaluate the relationship between caregiver characteristics and their acceptability of pharmacists intervening in children's antibiotic prescriptions for URTIs. Results: Responses from 246 caregivers who met the inclusion and exclusion criteria were analyzed. Mean caregivers' acceptability of pharmacists intervening in children's antibiotic prescriptions for URTIs was 3.25 out of 5 (±1.01). The ANCOVA model (adjusted R2 =.636) showed positive attitude toward pharmacists and being more accepting of health advice from pharmacists since the start of the COVID-19 pandemic were associated with higher caregiver acceptability of pharmacists intervening in children's antibiotic prescriptions. Caregivers with better relationships with their pharmacist also tend to have better attitudes toward pharmacists. Not wanting antibiotics for symptom relief was associated with decreased acceptability scores. Conclusion: Overall caregiver acceptability of pharmacists intervening in antibiotic prescriptions was slightly above neutral. Building a relationship with caregivers could help change their attitude and increase the acceptability of pharmacists intervening in children's antibiotic prescriptions. Caregivers seeking symptomatic relief may be more open to non-antibiotic alternatives. [ABSTRACT FROM AUTHOR]

Background: Antibiotics may be prescribed irrationally, which can lead to significant consequences including the emergence of antimicrobial resistance. Pharmacists can play a key role in enhancing the rational antibiotic prescribing. This study aimed to evaluate the current clinical practice of prescribing antimicrobial agents in pediatric wards and to assess the clinical and economic impact of pharmacist interventions on antibiotic prescribing. Methodology: This study was conducted at the pediatric wards of a general hospital, Babel, Iraq. The study population included all pediatric inpatients aged ≤ 12 years and receiving antibiotic. The study consisted of three phases. The first was a pre-intervention phase where data about antibiotic prescription was collected retrospectively. The second phase involved pharmacist intervention where the researcher had provided an oral presentation to the healthcare workers. The third phase involved prospective data collection which was compared with the pre-intervention data. Independent T-test was used to compare the differences in the parameters between the pre-and post-intervention phases. Results: The study included 250 children in each of the pre- and post-intervention phases who received antibiotic treatment. The medical records were reviewed retrospectively. Four antibiotics (amoxicillin, cefotaxime, vancomycin and meropenem) were significantly less frequently used in the post-intervention phase. Single antibiotic treatment was significantly higher in the post-intervention phase (p-value Conclusions: This study demonstrated that pharmacist intervention in general pediatric wards has resulted in favorable clinical and economic outcomes. This emphasizes the essential role pharmacists can play in rational antibiotic use, not only in the pediatric population but also in the adults.

This case report describes a pharmacist’s intervention with a 58-year-old female who presented with recurrent rhinosinusitis symptoms and limited treatment options due to a complicated allergy history. Using guidelines for treatment of acute bacterial rhinosinusitis coupled with a thorough antibiotic allergy assessment, the pharmacist developed a treatment plan that was acceptable to both the patient and the provider. Pharmacists can play an essential role in verification of allergies to both medications and non-pharmaceutical products, which further ensures patient safety as well as optimization of appropriate treatment methods.

Introduction: The high demand for psychiatric services has exceeded the capacity of available resources for behavioral health patients, forcing these patients to seek mental health care in the emergency department. Average lengths of stay for behavioral health boarders commonly extend over multiple days and prior-to-admission (PTA) medication administration may be delayed, which could lead to further deterioration and longer inpatient lengths of stay. Addition of a pharmacist-led medication reconciliation process and pharmacist integration into daily emergency department psychiatry rounds may decrease time to initiation of PTA medications and improve outcomes in this population. Methods: This is a retrospective review of adult patients who required a psychiatric emergency evaluation in a large rural academic medical center emergency department. Objectives were to determine the number and type of medication discrepancies found with pharmacist intervention, and to compare time to initiation of PTA medications with a pharmacist versus a nonpharmacist completing medication reconciliation. Results: A total of 139 patients were identified, 85 patients in August 2019 (no pharmacist [NP]) and 54 in October 2019 (pharmacist involvement [PI]). Among 484 medications reviewed in the PI group, 298 discrepancies were identified. The most common types of discrepancies were no longer taking (n = 99, 33%) and omission (n = 94, 32%). Time to administration of PTA medications was similar between NP and PI groups (median hours, interquartile range: NP: 10.8, 7.8-16.57; PI: 11.49, 6.16-16; P = .179). Discussion: This study depicted one of the many values of pharmacists in the hospital setting, especially in the behavioral health patient population where continuation of accurate PTA medications may prevent further clinical deterioration.

Aims: The aim was to quantify the relationship between pharmacist intervention and vancomycin‐associated acute kidney injury (AKI). Methods: Electronic databases were searched up to August 2020 for meta‐analyses of cohort studies and/or randomized controlled trials. Studies that compared the incidence of AKI in patients between post‐ and prepharmacist intervention were investigated. The primary outcome was incidence of AKI. We also evaluated the influence of pharmacist intervention in risk factors of vancomycin‐associated AKI. Results: The search strategy retrieved 1744 studies and 34 studies with 19 298 participants were included (22 published articles and 12 abstracts from conference proceedings). Compared with the preintervention group, the postintervention group patients had a significantly lower incidence of vancomycin‐associated AKI: 7.3% for post‐ and 9.6% for preintervention (odds ratio [OR] 0.52, 95% confidence interval [CI]; 0.41, 0.67], P <.00001). The rate of attaining target concentration was significantly higher in the post‐ than preintervention group (OR 2.86, 95% CI [2.23, 3.67], P <.00001). The postintervention group significantly improved the percentage of serum creatinine laboratory tests than preintervention group (OR = 3.24, 95% CI 2.02, 5.19], P <.00001). Patients postintervention had markedly lower risk of mortality than preintervention patients (OR 0.47, 95% CI [0.31, 0.72], P =.0004). Conclusion: Pharmacist intervention in vancomycin treatment significantly decreased the rate of vancomycin‐associated AKI, while improving efficacy and reducing mortality. We speculate that this is because the pharmacist interventions optimized the rationality of vancomycin therapy, monitoring of vancomycin trough concentration and the monitoring of patients' renal function. [ABSTRACT FROM AUTHOR]

Despite the availability of guidelines and official policies, antibiotic prophylaxis in clean surgery remains suboptimal. The aim of this study was to evaluate the clinical effects and cost-effectiveness of pharmacist-led intervention in the perioperative anti-infection prophylaxis of patients undergoing orthopedic internal fixation. We performed a retrospective analysis based on the medical records of internal fixation surgery in a tertiary hospital from July 2019 to June 2020. Data were divided into two groups based on whether a full-time pharmacist participated in the treatment. The research parameters included use of antibiotics, rationality of medication, postoperative complications, and related cost. To deal with selection bias, propensity score matching method was employed at a ratio of 1:1. Meanwhile, a cost-effectiveness analysis was used to evaluate the impact of pharmacist intervention on antibiotic prevention in internal fixation surgery. A total of 537 participants were included in this study. After matching, 236 patients were comparable in each group. During the pharmacist intervention period, less pharmacologic prophylaxis (96.6% vs 100.0%, p = 0.007) and shorter prophylaxis duration (1.60 vs 2.28 days, p < 0.001) were observed. The reasonable rate increased dramatically in usage and dosage (96.6% vs 83.9%, p < 0.001), timing of administration (94.5% vs 78.4%, p < 0.001) and medication duration (64.4% vs 37.7%, p < 0.001). In addition, pharmacist intervention yielded net economic benefits. A remarkable reduction was observed in average length of stay (10.43 vs 11.14 days, p = 0.012), drug cost ($610.57 vs $706.60, p = 0.001) and defined daily doses (2.31 vs 3.27, p < 0.001). The cost-effectiveness ratios, divided drug cost savings by cost of pharmacist time, were 28:1 for drug and 2:1 for antibiotics, respectively. Pharmacist-driven antibiotic stewardship for orthopedic internal fixation patients improved compliance with peri-procedure antibiotic prophylaxis, and reduced the cost and utilization of antibiotics. This helped to bring significant clinical and economic benefits. • Antibiotic prophylaxis in clean surgery remains suboptimal. • No data on pharmacist intervention in clean orthopedic surgery was available. • Pharmacist intervention improved compliance with antibiotic prophylaxis. • Pharmacist intervention yielded clinical and economic benefits. [ABSTRACT FROM AUTHOR]

Introduction: Studies on the appropriateness of antibiotic use among surgical patients are limited in developing countries, notably in India. Therefore, we aimed to evaluate the inappropriateness of antibiotic use, demonstrate the impact of clinical pharmacist interventions and determine the predictors of inappropriate use of antibiotics in the surgical units of a South Indian tertiary care hospital. Methods: This was a 1-year prospective interventional study on in-patients of the surgical wards to determine the appropriateness of the prescribed antibiotics by reviewing medical records using available antimicrobial susceptibility test reports and medical evidence. When inappropriateness in antibiotic prescriptions was identified, the clinical pharmacist discussed and conveyed apt suggestions to the Surgeon. Bivariate logistic regression analysis was applied to evaluate its predictors. Results: Among the 660 antibiotic prescriptions of 614 patients that were followed and reviewed, about 64% were inappropriate. Most inappropriate prescriptions were witnessed in the cases that involved the gastrointestinal system (28.03%). Among the inappropriate cases, 35.29% were attributed to an excessive regimen of antibiotic use which marked the highest. Based on the category of use, most of the antibiotics were used inappropriately as prophylaxis (76.7%) followed by empirical (71.31%). The increase in the percentage of the appropriate use of antibiotics resulting from pharmacist intervention was 95.06%. There was a significant link between inappropriate antibiotic use and the presence of two or three comorbid conditions, the use of two antibiotics, and length of hospital stay of 6-10 days and 16-20 days (p < 0.05). Conclusions: An antibiotic stewardship program in which the Clinical pharmacist is an integral part along with well-framed institutional antibiotic guidelines must be implemented to assure appropriate antibiotic use. [ABSTRACT FROM AUTHOR]

A woman in her 70s who was taking warfarin 3.75 mg/day had a prothrombin time-international normalized ratio (PT-INR) within the therapeutic range. Her medication for pulmonary hypertension was changed from bosentan to macitentan. After 40 days, she developed respiratory distress, anorexia, and vomiting caused by common cold. When she visited the pharmaceutical outpatient clinic without reservation, the pharmacist suspected that bosentan discontinuation, which cancelled cytochrome P450 (CYP) 2C9 and CYP3A4 enzyme induction, and decreased vitamin K intake due to appetite loss had enhanced warfarin effect, causing PT-INR prolongation. The pharmacist requested the physician to examine the patient's PT-INR. Results showed that her PT-INR was >7. Hence, she was urgently hospitalized. Warfarin and macitentan were discontinued, and the patient's PT-INR decreased to 1.77 after the intravenous administration of vitamin K. Her appetite improved, and warfarin 2 mg/day was resumed. Additionally, when she had been administered macitentan, her hemoglobin levels decreased from 10.8 to 6.6 mg/dL. Therefore, the pharmacist and the physician during hospitalization planned to resume treatment with bosentan, but not with macitentan. The pharmacist proposed to increase the warfarin dose to 3.75 mg since the bosentan and warfarin interaction could lower PT-INR. Thereafter, the patient's PT-INR was controlled within the therapeutic range, and her hemoglobin level was 8-9 mg/dL. The patient was discharged on day 17 of admission. Thus, pharmacist intervention plays a significant role in warfarin control with consideration of drug-drug interaction in patients receiving pulmonary hypertension treatment.

Although prescription review is an important role for pharmacists in anticancer drug therapy, there are no guidelines in Japan that specify what pharmacists should check for in chemotherapy regimens. This prospective multicenter survey aimed to investigate the implementation of chemotherapy regimen checks by pharmacists in general hospitals by focusing on 19 recommended confirmation items designed to enhance chemotherapy safety. This study involved 14 hospitals within the National Hospital Organization in different regions of Japan. The top five cancers in Japan (gastric, colorectal, lung, breast, and gynecological) were targeted and specific chemotherapy regimens were analyzed. This study assessed the amount of time required for regimen checks, the number of confirmation items completed, the number and the content of inquiries raised regarding prescriptions, and the pharmacists’ opinions using a questionnaire that had a maximum score of 10 points. Pharmacists checked 345 and 375 chemotherapies of patients in the control group (CG) and recommended items group (RIG), respectively. The mean time periods required for completing a chemotherapy regimen check were 4 min and 14 s (SD ±1 min and 50 s) and 6 min and 18 s (SD, ±1 min and 7 s) in the CG and RIG, respectively. The mean of the recommended items for the CG = 12.4 and for the RIG = 18.6. The items that the pharmacists did not confirm included urine protein (sixty-nine cases, 18.4%), allergy history (four cases, 1%), previous history (two cases, 0.5%), and a previous history of hepatitis B virus (sixty-nine cases, 18.4%). The number of inquiries for a doctor’s prescription order was higher in the RIG than in the CG (41 vs. 27 cases). This multicenter survey demonstrated the potential effectiveness of implementing 19 recommended confirmation items in the regimen checks by pharmacists in general hospitals other than cancer treatment collaborative base hospitals.

Background: The number of medications, number of administrations per day, dosing frequency on indicated day, and medication from multiple prescriptions are the medication factors prone to medication errors in self-management that have been previously reported. However, whether pharmacists actually intervene in medication factors that affect medication error occurrences in self-management is unclear. Therefore, we conducted this study to clarify these issues. Method: This study included patients who underwent self-management in the rehabilitation ward of Higashinagoya National Hospital. From April 2019 to March 2020, a one-pharmacist period existed, and from April 2020 to March 2021, a two-pharmacist period existed. The number of patient instructions and interventions were expected to increase with an increase in the number of pharmacists. Considering this to be an environment of differential interventions by pharmacists, a pre-post-test design was conducted with all self-managed patients in both the time periods. The primary and secondary endpoints were the proportion of medication error occurrences and proportion of pharmacist’s interventions in medication factors, respectively. Result: The proportions of medication error occurrences during the one-pharmacist and two-pharmacist periods were 41% (71/173) and 28% (51/180) (relative risk 0.690, 95% confidential interval 0.515–0.925), respectively. The proportion of pharmacist’s interventions in medication factors in the one-pharmacist period was 13% (22/173) and 22% (40/180) in the two-pharmacist period; there was an increase in the proportion of pharmacist’s interventions in medication factors in the two-pharmacist period. Conclusion: The proportion of medication error occurrences was significantly lower in the two-pharmacist period than that in the one-pharmacist period. This can be attributed to the increase in the proportion of pharmacist’s interventions in medication factors. Therefore, an environment in which pharmacists could intervene in the medication factors to prevent medication errors in advance is necessary. [ABSTRACT FROM AUTHOR]

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Abstract Background Clinical pharmacists play a role in limiting the disadvantages of pharmacotherapy for patients by detecting and resolving drug-related problems (DRPs) through medication reviews. Although their contributions to patient care have been analyzed and understood in various countries, the role of Japanese clinical pharmacists in this context remains to be clearly elucidated. Thus, in this study, we aimed to elucidate the detection of DRPs by clinical pharmacists and determine the potential impact of pharmacist interventions in Japan. Methods This study was conducted in a 273-bed hospital and targeted hospitalized patients over a period of 6 months. DRPs detected by clinical pharmacists during the study period were investigated and classified into 10 types. Furthermore, medications were categorized according to the Anatomical Therapeutic Chemical classification. A review committee consisting of two pharmacists independently reviewed the pharmacist interventions on a six-point scale (extremely significant, very significant, significant, somewhat significant, no significance, adverse significance) according to the potential impact on patient care. Results During the study period, 1711 patients (mean age: 71.2 years, 54.1% male) were included, and 2149 DRPs were detected (1.26 DRPs/patient). Pharmacists intervened in all the DRPs detected. The most common DRP was supratherapeutic dosage (19.3%), followed by untreated indication (18.1%). The most common medication classification causing DRPs was “Antiinfectives for Systemic Use” (25.1%), followed by “Alimentary Tract and Metabolism” (19.9%). Most of the pharmacist interventions (99.6%) were rated “somewhat significant” or more significant, of which 1.1% were rated “extremely significant,” and none were rated as “adverse significance.” Conclusions Our results show that in Japan, as in other countries, clinical pharmacists detect and resolve DRPs in hospitalized patients through medication review. Our findings also show that clinical pharmacists have a positive impact on patient care and suggest the need for their involvement.