International Journal of Clinical Pharmacy最新文献

Sexual and reproductive health is an important aspect of a woman's health and her ability to access safe, effective, affordable, and acceptable forms of fertility regulation, including contraception. This commentary piece introduces the barriers and facilitators to community pharmacists' practising in sexual and reproductive health, and compares and contrasts interventions taking place internationally, compared to key clinical trials occurring in Australia on an expanded scope of community pharmacy practice, in prescribing the oral contraceptive pill (OCP). Modelling the practices already occurring in other high-income countries, Australia is striving to remove barriers and improve accessibility to contraceptive care, by enabling community pharmacists to prescribe contraception.

Background: Restoration of intestinal function after open surgery remains a significant challenge in gynecological practice. Bacillus coagulans TBC169 probiotics may enhance intestinal motility and recovery.

Aim: This randomized controlled trial aimed to evaluate the efficacy and safety of Bacillus coagulans TBC169 in promoting intestinal function recovery after gynecological open abdominal surgery.

Method: Patients undergoing open surgery were randomly assigned to high-dose (HDG), conventional-dose (CDG), or placebo-controlled (PCG) groups. The primary outcome was the time to first flatus (TFF). Secondary outcomes included time to first defecation (TFD), time to first bowel sounds (TFBS), duration of hospital stay (DHS), and postoperative complication rate (PCR).

Results: A total of 114 patients were included, with 38 patients allocated to each group. TFF was significantly shorter in the CDG (25.8 h vs. 38.1 h, P < 0.001) and the HDG (23.1 h vs. 38.1 h, P < 0.001) than the PCG. TFBS was significantly reduced in the CDG (16.1 h vs. 19.3 h, P < 0.05) and the HDG (14.3 h vs. 19.3 h, P < 0.001). Patients in the HDG had a significantly shorter TFD than the PCG (61.2 h vs. 66.4 h, P < 0.05). However, DHS did not differ significantly among the groups. PCR was markedly lower in the CDG (34.2% vs. 68.4%, P < 0.01) and HDG (21.1% vs. 68.4%, P < 0.001) compared to the PCG. No adverse events were reported across the groups.

Conclusion: Bacillus coagulans TBC169 accelerates intestinal function recovery and reduces postoperative complications following gynecologic open surgery.

Trial registration: The study protocol was registered with the China Clinical Trials Registry (ChiCTR2200059518).

Background: Multi-morbidity is associated with multiple medication use, which potentially increases the risk of adverse drug events. Pharmacist-led medication reviews have been introduced to meet these challenges.

Aim: To evaluate the implementation of pharmacist-led medication reviews for older patients admitted to an orthopedic ward in terms of quality and safety from the perspectives of patients, hospital-based physicians, nurses, and healthcare assistants.

Method: Patients (n=11) were interviewed, with the interviews having a reflexive thematic analysis using the hermeneutic approach, while healthcare-professionals' (HCPs) (n=26) perspectives on pharmacist-led medication reviews were assessed using questionnaires.

Results: The qualitative patient interviews revealed four themes: (1) Positive perception of pharmacists' medication communication, (2) Mixed perceptions of a medication review, (3) Satisfaction with the general outcome of the medication review, and (4) Safety perception with medication treatment. Twenty-six HCPs completed the questionnaire (response rate 48%) with a distribution of 10 hospital-based physicians (38%), eight nurses (31%), and eight healthcare assistants (31%). Almost 85% of the HCPs (n = 22) were familiar with the pharmacist conducting medication reviews. More than 70% of the HCPs reported that pharmacist-led medication reviews contributed to increased quality of admitted patients' medication use.

Conclusion: High levels of satisfaction with the outcomes of the medication reviews-particularly regarding quality, patient safety, and their overall positive impact on the ward-indicate that both patients and HCPs perceived the service as highly valuable in supporting patient care throughout the medication process.

Background: While medication is a recognized risk factor of delirium, there is currently a lack of detailed information on managing and preventing medication-induced cases.

Aim: This review summarizes the information provided in neurology guidelines on medication-induced delirium in patients with and without dementia to inform guidance on prevention and management strategies.

Method: A systematic literature review was conducted across 114 neurological and medical organisations, Guideline Central and PubMed. Guidelines, consensus guidelines, white papers, frameworks, protocols, standard procedures, action plans and strategic documents detailing the prevention and management of medication-induced delirium in adults with or without dementia were included. Title and full-text screening was completed independently by two reviewers using PICOS. AGREE II was used to assess reporting quality. A data extraction tool was designed based on the Cochrane Effective Practice and Organization of Care Review Group (EPOC) checklist and a mixed methods approach to synthesis adopted. The systematic review protocol was registered with International Prospective Register of Systematic Reviews (PROSPERO) [ID: CRD42022366025].

Results: Out of 143 guidelines identified, 30 were included. Information for 140 individual medications was extracted. Medications most frequently cited included sedatives (n = 24/80%), opioids (n = 22/73,3%), psychoactive drugs (n = 21/70%) + anti-convulsants (n = 14/46,7%), anti-cholinergic agents (n = 20/66,7%), antihistamines (n = 18/60%), and steroids (n = 16/53,3%). Despite a consistently high-quality rating (n = 19, 63,3%), the detail provided often lacks specificity about pharmacological mechanisms, individual risk, dosing instructions, associated symptoms, therapeutic alternatives and avoidable drug-drug combinations. In relation to dementia, detailed information on the use of antipsychotics, cholinesterase inhibitors and benzodiazepines was extracted. No papers were excluded based on their quality.

Conclusion: No single guideline contains enough information on the risk, prevention, and management of medication-induced delirium to sufficiently support clinical decision making.

Background: Polypharmacy is common in older adults and may be associated with poor outcomes. However, methods used to define polypharmacy are rarely reported precisely, with potential implications for polypharmacy exposure estimates.

Aim: The aim was to investigate prevalence estimates according to different methods in an Australian population-based sample of older adults.

Method: This cross-sectional study included 735 adults aged ≥ 60 years participating in the Geelong Osteoporosis Study. Current prescription, non-prescription and complementary and alternative medicines were self-reported. Counting methods included the number of active ingredients and unique products. Polypharmacy and hyperpolypharmacy were determined using ≥ 5 and ≥ 10 medicine cut points respectively. Prevalence was estimated using ingredient- and product-level counts according to criteria defined by medicine schedule and type (i.e. scheduled prescription, non-prescription). Non-parametric testing measured differences between counting methods, univariate logistic regressions investigated disagreement between total counts and polypharmacy exposure.

Results: Polypharmacy prevalence (scheduled prescription medicines) was 30.3% and 35.9% (products versus ingredients). Prevalence increased to 52.8% and 57.3% when counts considered any medicine. Adults aged ≥ 80 years were most likely to use prescription combination products (OR 2.22 [95% CI 1.46, 3.35] p < 0.01), however, age was not associated with disagreement between product and ingredient polypharmacy exposure. Being male was associated with both prescription combination product use (OR 1.79 [95% CI 1.29, 2.47] p < 0.001) and disagreement between polypharmacy exposures (OR 2.29 [95% CI 1.15, 4.47] p=0.02).

Conclusion: Polypharmacy prevalence estimates varied substantially depending on the method applied. These data indicate the need for standardised reporting specific to medicines data and polypharmacy measures.

Background: Prescribing cascades occur in clinical practice when a medication causes an adverse drug reaction (ADR), which is addressed by prescribing additional medication.

Aim: The aim was to provide proof-of-concept for pharmacy-led interventions to reverse or prevent prescribing cascades.

Method: Two community pharmacies each tested two approaches. To reverse prescribing cascades, ten cascades were selected from literature. Dispensing records were screened to identify patients with these cascades. To prevent prescribing cascades, patients who started medications associated with five of these cascades were telephoned one month after their first dispensing to discuss ADRs. Pharmacists assessed the need to intervene together with prescribers. Primary outcome was the proportion of patients with a treatment change initiated. Secondary outcomes were time investment, potential cost-savings, and pharmacists' experiences.

Results: To reverse prescribing cascades, 24 patients were included. For eight the prescriber was consulted, resulting in the reversal of three cascades. Forty-four patients were included to prevent prescribing cascades. Six of them experienced an ADR that could lead to a prescribing cascade. For two patients interventions were conducted to prevent this. The estimated time investment to identify patients possibly in need of intervention was 4.5 h for the reversing approach and 4.8 h for the preventing approach, while follow-up actions required 1.8 h and 0.5 h, respectively. Both approaches could be cost-saving. Pharmacists considered both approaches relevant but identified a knowledge gap on how to intervene for some cascades.

Conclusion: Pharmacy-led interventions may reverse and prevent prescribing cascades, but more efficient screening methods and tools are needed before further implementation.

Background: Anti-tuberculosis drug-induced liver injury (ATLI) is a significant adverse drug reaction with genetic susceptibility implications.

Aim: This study aimed to integrate findings from systematic reviews and meta-analyses on genetic polymorphisms associated with ATLI risk, enhance evidence synthesis, and identify susceptibility gene polymorphisms linked to ATLI occurrence.

Method: The protocol was registered in PROSPERO (CRD42024517311). Systematic searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were conducted to identify eligible studies from inception to February 21, 2024. Two authors independently reviewed eligibility, extracted data, and assessed quality. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to evaluate associations between genetic polymorphisms and ATLI susceptibility.

Results: A total of 25 meta-analyses were included, including 57 single nucleotide polymorphisms (SNPs) in 15 candidate genes. Significant associations were found for the glutathione S-transferase M1 (GSTM1) null genotype (OR = 1.43, 95% CI: 1.18-1.73, P < 0.001) and N-acetyltransferase 2 (NAT2) polymorphisms, including rs1799929 (dominant model, OR = 1.35, 95% CI: 1.12-1.63, P < 0.001), rs1799930 (dominant model, OR = 1.43, 95% CI: 1.23-1.66, P < 0.001), rs1799931 (dominant model, OR = 1.22, 95% CI: 1.02-1.46, P = 0.03), and the slow acetylator (SA) phenotype (OR = 2.91, 95% CI: 2.43-3.49, P < 0.001). No significant association was found between the CYP2E1 RsaI/PstI polymorphism (C1/C1 genotype) and ATLI risk (dominant model, OR = 0.79, 95% CI: 0.61-1.02, P = 0.08).

Conclusion: This umbrella review confirms that the GSTM1 null genotype, NAT2 polymorphisms (rs1799929, rs1799930, rs1799931), and the slow acetylator phenotype are associated with increased ATLI risk. These findings provide a foundation for further research on genotype-guided approaches to mitigating ATLI.

Background: Previous studies have shown that reducing drug-related problems (DRPs) may improve therapeutic outcomes in patients with Parkinson's disease (PD).

Aim: To investigate the impact of pharmacist participation in Parkinson's disease clinic on the number of DRPs, clinical outcomes, and the quality of life of PD patients.

Method: This single-blinded randomised controlled trial was conducted at the Parkinson's Disease and Movement Disorders Clinic. Patients aged ≥ 18 years, diagnosed with idiopathic PD for at least 3 years, and receiving antiparkinsonian drugs were randomly assigned (1:1) to the pharmacist-physician (PP) or usual care (UC) groups. The primary outcome was changes in the number of DRPs from baseline to 24 weeks between groups. Secondary outcomes included the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) score, eight-item version of the Parkinson's Disease Questionnaire (PDQ-8) score, and Patients' Global Impression of Change (PGIC) score at week 24.

Results: A total of 80 patients were randomised, with 40 in each group. The mean number of DRPs reduced in both groups; however, the reduction was greater in the PP group compared to the UC group (- 7.2 ± 3.6 vs. - 3.0 ± 1.8, p < 0.001), especially non-adherence issues. The MDS-UPDRS and PDQ-8 scores showed significantly greater improvement in the PP group. A higher proportion of patients in the PP group achieved improvement in PGIC scales compared to those in the UC group.

Conclusion: Our findings demonstrated that pharmacist-physician collaboration service in the PD clinic positively impacted patient outcomes.

Trial registration: ClinicalTrials.gov NCT05410210 (date 13 May 2022).

Background: The second victim phenomenon, involving emotional and psychological distress after adverse events, is underexplored among pharmacy professionals. The validated Second Victim Experience and Support Tool measures these experiences and support options, with the improved version also assessing resilience.

Aim: This study aimed to validate the Second Victim Experience and Support Tool-Revised, measure the second victim phenomenon, and present results among pharmacy professionals in Serbia.

Method: This cross-sectional study included 350 pharmacy professionals (MPharm and technicians). The questionnaire, with 9 factors and 35 statements, was translated and adapted following guidelines, and the content was validated by five experts. A pre-test with 30 participants ensured clarity, followed by Confirmatory Factor Analysis for construct validity and Cronbach's Alpha for reliability.

Results: Content validity was confirmed with item scores from 0.8 to 1 and a mean scale score of 0.83. Factor analysis identified 9 factors and 30 items (Chi-square = 545.6, degrees of freedom = 366, p < 0.001). The model fit was supported by a Root Mean Square Error of Approximation of 0.037, a Comparative Fit Index of 0.958, a Tucker-Lewis Index of 0.950, and a Standardised Root Mean Square Residual of 0.040. Reliability analysis showed a Cronbach's alpha of 0.88, with factor values from 0.60 to 0.90. Among participants, 49.5% feared future events, 47.4% felt exhausted, 22.6% considered quitting, 72.6% valued peer support, and 28.9% improved work quality.

Conclusion: The Serbian resilience measuring tool is valid and reliable, effectively evaluating second victim experiences and support, with half of pharmacy professionals affected.