International Journal of Clinical Pharmacy最新文献

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed to control pain, inflammation, and fever in upper respiratory tract infections (URTIs).

Aim: To explore the relative effectiveness and gastrointestinal (GI)-related safety of individual NSAIDs to control symptoms of URTIs.

Method: Using an Italian primary care data source, we identified patients aged ≥ 15 years who were newly prescribed NSAIDs for URTIs between 2013 and 2022. Switching to another NSAID for the same indication within the 30-day follow-up was a proxy for drug effectiveness. The study outcome for GI safety analysis was upper gastrointestinal bleeding (UGIB).

Results: In a cohort of 57,971 patients, the most prevalent subgroups were those treated with ketoprofen (39.5%) and dexibuprofen/ibuprofen (22.4%). Ketoprofen showed the lowest rate of switching to another NSAID [Hazard Ratio (HR) 0.40 (95% CI 0.20-0.83)] against acetylsalicylic acid/coxibs/diclofenac. Dexibuprofen/ibuprofen showed similar results [HR 0.50 (95% CI 0.22-1.10)], with no significant association. Ketoprofen and dexibuprofen/ibuprofen were prescribed as lysine and arginine salts in 85 and 6% of URTIs sufferers, respectively. Across NSAIDs, we did not find any significant difference in the risk of UGIB.

Conclusion: Our findings indicated that various NSAIDs may exhibit differing levels of effectiveness in treating URTIs, particularly those formulated for quick onset of action. No NSAIDs-UGIBs association was found. Further prospective, larger studies are needed to confirm these findings.

Background: Digital technology has been widely integrated into healthcare. This encompasses knowledge, skills, and practices related to the development and use of health technologies. The behavior of health professionals is critical to the adoption of these technologies.

Aim: This study aimed to investigate factors associated with hospital pharmacists' intention to use digital technology in their daily practice using the Theory of Planned Behaviour (TPB).

Method: In this cross-sectional study, a paper-based survey was conducted among hospital pharmacists who attended the National Hospital Pharmacy Congress in Türkiye in March 2022. A valid and reliable Turkish scale based on the TBP was used to identify factors associated with the intention score by a multiple linear regression model.

Results: One hundred ten participants completed the survey (response rate: 44.0%). Seventy percent of pharmacists reported that they had not received prior training in digital technologies. More than eighty percent of the participants said they intend to use digital technology in daily practice. The higher scores of attitudes (p = 0.005), self-efficacy (p < 0.001), and working place (p = 0.017) were associated with increased intention scores.

Conclusion: Positive attitudes, higher self-efficacy, and working in tertiary hospitals were associated with hospital pharmacists' intentions to use digital technology in daily practice. These factors should be considered in developing interventions to promote digital technology use of hospital pharmacists.

Background: Comprehensive geriatric assessment evaluates key health domains for older adults, focusing on medicine optimisation and medication adherence to improve tolerability and quality of life for older adults on systematic anticancer therapy. The Royal Marsden (RM) Senior Adult Oncology Programme (SAOP) provides multidisciplinary geriatric assessment and interventions for patients ≥ 70 undergoing systematic anticancer therapy.

Aim: We designed an ACCESS (eArly identifiCation advanCed gEriatric aSsesSment) tool to enhance efficiency of SAOP outpatient clinics by facilitating geriatric assessment including medications, nutrition, social support, mood, and functional assessments.

Setting: SAOP at RM NHS Foundation Trust, London, UK.

Development: Developed by SAOP pharmacist and clinical nurse specialist with input from SAOP multidisciplinary team, the ACCESS tool includes medication review patient counselling deprescribing, and comorbidity management, aligning with the Royal Pharmaceutical Society Advanced Pharmacy Framework.

Implementation: From January to December 2022, ACCESS was implemented in three steps: screening with Senior Adult Oncology Programme v 3 (SAOP3) questionnaire, remote consultation based on results, and medication review and patient counselling for complex medication needs, enhancing patient engagement and treatment understanding.

Evaluation: The practice was audited through the implementation process. Quantitative data from staff and 100 patients who were users of the SAOP service and ACCESS tool revealed higher medication adherence, improved identification of inappropriate medications, and enhanced confidence in managing complex geriatric oncology cases.

Conclusion: The ACCESS tool, led by clinical pharmacist and clinical nurse specialist has improved outpatient clinic efficiency, patient satisfaction, and healthcare coordination. It allows personalised follow-up plans for older adults with complex health issues on anticancer therapy. Regular multidisciplinary team meetings and digital health records enhance care coordination and decision-making for older adults with cancer.

Background: Falls in older adults might increase due to polypharmacy.

Aim: This study aimed to explore the association between preadmission medications and history of falls in older inpatients.

Method: This observational study of inpatients aged ≥ 65 years was conducted over 4 years at Ballina Hospital, Australia. The Medication Regimen Complexity Index (MRCI), Drug Burden Index (DBI), and Anticholinergic Effect on Cognition (AEC) scores were calculated for preadmission medications. Polypharmacy and falls questionnaires were administered to identify falls in the past 6 months and aptitude toward medication use.

Results: Overall, 194 participants with a mean age of 80.2 (SD 8.0) years were included. The mean daily number of regular medications was 7.8 (SD 3.9) and the mean MRCI score was 22 (SD 12.6). Among the participants, 107 (55%) reported falls in the past 6 months and 47 (24%) reported ≥ 2 falls. Age and hearing impairment were positively associated with falls (p = 0.007 and p = 0.003, respectively). History of falls was positively associated with a MRCI score of ≥ 20 (p = 0.018), an AEC score of ≥ 2 (p = 0.010) and a DBI score of ≥ 1 after adjustment for age (p = 0.041). Forgetting medications was associated with falls (p = 0.043). Antihypertensive use did not increase falls risk.

Conclusion: Implementing a decisive approach to simplify complex medication regimens, along with patient-focused medication management strategies, may help reduce the risk of falls in older adults. Sedatives and anticholinergic medications increase the risk of falls and should be avoided whenever possible.

Background: Chronic Obstructive Pulmonary Disease (COPD) is associated with low health-related quality of life and high costs to healthcare systems, particularly due to hospital admissions and exacerbations. Medicines, inhalers especially, reduce the risk of hospitalisations and exacerbations, but factors influencing medicine-taking behaviours are not fully understood.

Aim: To explore experiences of people with COPD related to medicines, and followingly identify and characterise any barriers and enablers related to medicine-taking behaviours using the Theoretical Domains Framework (TDF).

Method: Semi-structured qualitative interviews were conducted and included ten people with COPD who had previously been admitted to hospital. Systematic text condensation was used inductively in the primary analysis of the interviews. In the secondary analysis, meaning units from the primary analysis were mapped to the TDF and summarised as barriers and enablers.

Results: Five major themes were developed in the primary analysis: (1) health literacy and information needs, (2) patient autonomy, (3) lack of access to medicines, (4) lack of effect from medicines, and (5) experiences of medicines-related issues. In the secondary analysis, thirteen barriers and nine enablers were mapped to nine out of the fourteen domains of the TDF.

Conclusion: People with COPD experience challenges related to medicines which need to be addressed by researchers and healthcare providers. The identified barriers and enablers mapped to the TDF can guide and inform future design of interventions and health care services.

Background: The rapid advancement of generative artificial intelligence (AI) in recent years has led to its increased application across various fields including education. One area where AI can significantly impact is clinical education, particularly in the preparation and execution of objective structured clinical examinations (OSCEs).

Aim: This study aimed to evaluate the impact of AI-generated study material and feedback on the academic performance and level of anxiety of pharmacy students in formative OSCE.

Method: This was a 4-week (June-July 2024) randomized controlled study. Students of 6th semester PharmD program were randomized into either an intervention or control group. The intervention group received intervention which comprised a comprehensive training session on how to use AI tools (ChatGPT, Gemini and Perplexity) for generating study materials with personalized feedback, in addition to usual OSCE instructions. The control group only received the usual OSCE instructions. In addition, all students completed the test anxiety inventory (TAI) questionnaire before the OSCE.

Results: Eighty-eight (40 male, 48 female) out of 92 (96%) students attended the OSCE and completed the TAI questionnaire. Each group had 44 (50%) students. The mean OSCE mark was 13.26 (± 5.05) out of 30. No significant difference was found between the intervention [12.98 (± 5.15)] and control [13.54 (± 5.00)] groups regarding mean OSCE marks (p = 0.550). Similarly, no significant difference was found between the groups regarding the total TAI score (p = 0.917).

Conclusion: While the use of AI tools did not improve the academic performance of students or reduce test-related anxiety, they did not negatively impact these outcomes either. Future research should investigate the long-term effects of AI-based interventions on educational outcomes.

Background: Although the mechanism underlying flutamide- or bicalutamide-induced liver injury may be immune related, the details remain unclear. If this mechanism is immune related, steroid use may be considered as a treatment option.

Aim: Disproportionality analysis was conducted to evaluate the effect of concomitant steroid use on flutamide- and bicalutamide-induced liver injury.

Method: Male patients aged 20 years or older who were receiving nonsteroidal anti-androgens from April 2004 to October 2023 were screened from the Japanese Adverse Drug Event Report database. Data on liver injury, age, weight, height, steroid use, obesity, hepatic stenosis, alcohol-related hepatic disorders, hepatitis B and C, and common drugs known to cause drug-induced liver injury were analyzed. Liver injury was defined by the Standardized Medical Dictionary for Regulatory Activities query index (code 20000006, version 27.0).

Results: Among 142,430 patients, 2,316 were administered nonsteroidal anti-androgens. Reports of liver injury were disproportionate depending on the agents used (reporting odds ratio [ROR], 1.29; 95% confidence intervals [CI], 1.13-1.46), especially among flutamide or bicalutamide users (flutamide: ROR, 6.09; 95% CI, 4.51-8.23; bicalutamide: ROR, 1.24; 95% CI, 1.05-1.48). Multivariable logistic regression analysis correlated steroid use with a lower risk of flutamide- or bicalutamide-induced liver injury (flutamide: odds ratio, 0.07; 95% CI, 0.01-0.52; bicalutamide: odds ratio, 0.45; 95% CI, 0.21-0.96).

Conclusion: Our findings suggest that flutamide and bicalutamide may increase the risk of liver injury compared to enzalutamide, apalutamide, and darolutamide. Furthermore, our study indicated that steroid use could aid in the management of liver injury.

Background: Polypharmacy is often required for older adults with hypertension, and excessive treatment is associated with a high risk of adverse reactions, including hypotension.

Aim: To evaluate the deprescribing of antihypertensive medications guided by pharmacists using home blood pressure monitoring in older adults with hypotension.

Method: A subgroup of older adults with signs or symptoms of hypotension, included in the MINOR clinical trial, was analysed. In the MINOR procedures, each patient was provided with a device to conduct blood pressure measurement at home for 1 week, following which a report was generated and shared with pharmacists (intervention group) or family physicians (control group). In the intervention group, a pharmacist suggested optimising pharmacotherapy; meanwhile, in the control group, a family physician alone determined the necessary treatment adjustments. Differences in mean blood pressure, the patients with symptoms/signs of hypotension, and the antihypertensive medication deprescribing between both groups were analysed.

Results: Seventy-two patients were evaluated (35, control group; 37, intervention group). The intervention group showed a significant reduction in medication prescriptions (- 28.6%; P < 0.001), especially beta-blockers (- 74.2%), loop diuretics (- 83.3%), and aldosterone antagonists (- 80%). The mean office blood pressure in the intervention group increased (14.1 mmHg systolic and 6.9 mmHg diastolic), remaining below the target range (140/90 mmHg). The intervention group showed a significantly reduction in hypotensive symptoms than the control group (64.9% vs. 20%) (P < 0.001).

Conclusion: The data highlight an important role for pharmacists in optimizing hypertension management in older people. Deprescribing antihypertensives can limit symptomatic hypotension.

Trial registration: Registered on ClinicalTrials.gov under number NCT04861727.

Background: Narrative medicine is a recent cross-disciplinary approach which through aesthetic activities such as reading fiction and creative writing aims to encourage empathy, reflection, professionalism, and trustworthiness in the encounter between patients and health care professionals.

Aim: The aim of this study was to evaluate changes in level of empathy after a postgraduate course in narrative medicine among pharmacists conducting medication counselling.

Method: During 2020-2021, three courses in narrative medicine among pharmacists with the aim to enhance empathy were held in Odense, Denmark. The primary outcome was the pharmacists' self-reported level of empathy before and after the course measured with Jefferson Scale of Empathy (JSE), which is a validated 20 item scale with higher scores indicating higher levels of cognitive empathy.

Results: A total of 33 community and hospital pharmacists participated in the three courses. The pharmacists' median age was 41 years, 91% were female, 76% were working in community pharmacy, and 47% were, according to themselves, rare readers. The pharmacists completed the JSE scale before and after the course. A statistically significant increase was found in mean total JSE score from 109.9 ± 17.1 before the course to 115.7 ± 14.6 after the course (p = 0.0362).

Conclusion: Following the course in narrative medicine the level of empathy for the pharmacists according to JSE was enhanced. We recommend that future studies also use patient-reported outcomes to explore if the self-experienced enhanced empathy among pharmacists affects the patients' experience of their encounters.