International Journal of Clinical Pharmacy最新文献

Introduction: Inhaled therapies are essential for managing asthma and chronic obstructive pulmonary disease (COPD), but device choice carries environmental consequences. Inhaler devices influence climate impact; propellant-based metered-dose inhalers (MDIs) have substantially higher carbon footprints than non-propellant inhalers (NPIs). Ireland has committed to net-zero greenhouse gas emissions by 2050, making prescribing practices a relevant focus for mitigation.

Aim: To describe national dispensing patterns of inhaled respiratory medicines and estimate associated CO₂-equivalent (CO₂e) emissions in Irish primary care, 2020-2022.

Method: We analysed Health Service Executive-Primary Care Reimbursement Service (HSE-PCRS) dispensing data for inhaled respiratory medicines (ATC R03) products. Items were classified as MDIs or NPIs. Trends of inhalers use were expressed as year-on-year inhalers dispensed. We conducted scenario analysis in which 10%, 25%, and 50% of 2022 MDIs use were replaced with NPIs to calculate the reduction in carbon emissions. Notably, PCRS schemes cover ~ 43% of the Irish population (predominantly older adults and a lower income group).

Results: Between 2020 and 2022, a total of 9.94 million inhalers were dispensed under HSE-PCRS schemes, with annual volumes rising from 3.04 million (2020) to 3.60 million (2022). MDIs increased from 1.50 million (2020) to 1.79 million (2021) and 1.95 million (2022), while NPIs declined - 15.7% in 2021 and then rebounded + 26.8% in 2022. The MDIs share of all inhalers changed from 49.2% (2020) to 57.9% (2021) to 54.2% (2022) for which estimated MDIs carbon emissions were 28.6, 34.6, and 37.6 kt CO₂e, respectively. This emission was accounted for 95-96% of inhaler-related emissions annually. In scenario analyses, replacing 10%, 25%, and 50% of 2022 MDIs use with NPIs resulted in estimated emission reduction of ~ 3.6, 8.9, and 17.9 kt CO₂e, respectively.

Conclusion: The results show how MDIs influence the carbon footprint of the health sector and they encourage healthcare providers to support sustainable alternatives. When clinically appropriate, choosing sustainable devices provides significant, short-term CO2 savings without sacrificing treatment.

Introduction: Severe cutaneous adverse reactions (SCARs) are rare but potentially life-threatening. Children and adolescents are especially vulnerable due to developmental pharmacology, immature immune systems, and limited premarketing safety data. However, large-scale evidence of drug-specific SCAR patterns in pediatric populations remains limited.

Aim: To investigate the epidemiology, clinical features, drug associations, and safety signals of SCARs in children and adolescents using the FDA Adverse Event Reporting System (FAERS).

Method: Reports of SCARs in patients aged ≤ 18 years were retrieved from FAERS from Q1 2004 to Q2 2024 and identified using narrow-scope Standardised MedDRA Queries (SMQs). Data cleaning followed the FDA-recommended procedures. Disproportionality analysis was performed using four methods: Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN; yielding Information Component, IC), Multi-item Gamma Poisson Shrinker (MGPS), and empirical Bayes geometric mean (EBGM). Drug-label reviews were used to compare the signal detection results with existing safety warnings.

Results: A total of 7183 pediatric SCAR reports were included. The number of reports has increased over time, with adolescents (13-17 years) and school-aged children (7-12 years) accounting for 68% of cases. The most frequently reported Preferred Terms were drug reaction with eosinophilia and systemic symptoms (DRESS; 32.5%), Stevens-Johnson syndrome (SJS; 27.9%), and toxic epidermal necrolysis (TEN; 19.0%). Hospitalization occurred in 64.5% of cases, and 6.3% were fatal. Among the 2005 cases with available onset time, 82.7% developed within 30 days of drug exposure. Thirty-eight drugs showed positive signals, including lamotrigine, phenytoin, sulfamethoxazole, and phenobarbital. Four drugs, ranitidine, anakinra, clonazepam, and rifampin, showed signals without corresponding warnings in the FDA pediatric labeling.

Conclusion: SCARs in children and adolescents show distinct patterns, high hospitalization and mortality, and strong links with antiepileptics and anti-infectives. Strengthening pediatric pharmacovigilance, implementing risk-alert systems, and promoting genotype-guided prescribing may help prevent these severe reactions.

Introduction: Pneumonia is a leading cause of morbidity and mortality worldwide, with community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) representing the two most common subtypes. Antimicrobials are central to treatment; however, systematic reviews (SRs) evaluating their use have reported highly variable outcomes, limiting evidence synthesis and comparability. The development of a core outcome set (COS) may address this gap.

Aim: To summarize the primary outcomes reported in SRs of antimicrobials for adult pneumonia and to construct an preliminary list of candidate outcomes to inform COS development.

Method: A systematic search was performed in PubMed, Embase, Cochrane Library, CNKI, Wanfang Data, and China Science and Technology Journal Database from inception to December 2024. Eligible studies included SRs or meta-analyses that evaluated antimicrobial therapy in adults (≥ 18 years) with CAP or HAP. Two reviewers independently screened the studies, extracted data on the study characteristics, pneumonia type, severity assessment tools, and outcomes. The Corrected Covered Area (CCA) was calculated to quantify the overlap in primary outcome reporting. Outcomes were grouped by pneumonia type and severity and categorized into five domains following the COMET taxonomy.

Results: A total of 97 SRs were included. Twenty-one distinct primary outcomes were identified, with limited overlap. Mortality and clinical success were the most frequently reported outcomes, though inconsistently defined across studies. Significant variability was noted in the definitions and time points of outcomes, as well as in severity assessment tools. Registered SRs reported fewer outcomes than non-registered ones.

Conclusion: There is considerable variation in primary outcome reporting in antimicrobial SRs for adult pneumonia. Mortality and clinical success are the most commonly reported outcomes, but their definitions lack consistency. Developing subtype- and severity-specific COS is crucial for standardizing outcome reporting and improving evidence synthesis.

Introduction: Sodium-glucose cotransporter‑2 (SGLT‑2) inhibitors are widely used in type 2 diabetes, but their effect on the incidence of diabetic retinopathy remains uncertain.

Aim: To update the evidence on the relationship between SGLT-2 inhibitors and diabetic retinopathy incidence using a Bayesian network meta‑analysis (NMA) of randomised controlled trials (RCTs).

Method: A systematic search on Embase, PubMed, Web of Science, and ClinicalTrials.gov to 25 August 2025 identified RCTs in adults with type 2 diabetes comparing an SGLT‑2 inhibitor with placebo or active comparators and reporting diabetic retinopathy outcomes. A random‑effects Bayesian NMA estimated odds ratios (ORs) with 95% credible intervals (CrI) with ranking based on the surface under the cumulative ranking curve (SUCRA). Evidence quality was assessed using the Cochrane Risk-of-Bias tool and Confidence in Network Meta-Analysis (CINeMA). Network meta-regression explored treatment‑by‑covariate interactions including baseline diabetic retinopathy risk. Model‑based NMA (MBNMAdose) evaluated dose-response patterns.

Results: Thirty RCTs (eight gliflozins; 70,310 participants across study arms) formed a star‑shaped network without head‑to‑head trials. CINeMA indicated low confidence for most comparisons, mainly due to imprecision, with some concerns about indirectness and generally no concerns regarding heterogeneity or incoherence. No SGLT‑2 inhibitor altered diabetic retinopathy risk versus placebo (all 95% CrIs included 1.0). Probability rankings suggested empagliflozin most likely to be favourable and luseogliflozin least favourable (SUCRA values of 85.88% and 22.96%, respetively), but between‑drug differences were not statistically significant. Network meta‑regression identified effect modification by baseline diabetic retinopathy risk: higher placebo event rates were associated with lower relative odds under SGLT‑2 inhibition. No dose-response signal for diabetic retinopathy was detected, in contrast to dose‑related improvements in HbA1c and reductions in body weight and blood pressure.

Conclusion: SGLT‑2 inhibitors showed a neutral effect on the incidence of diabetic retinopathy. Baseline diabetic retinopathy risk appears to moderate relative effects, and no dose-response was evident for diabetic retinopathy. Choice among agents should be driven by overall efficacy, safety and patient factors rather than retinal risk; dedicated trials with prespecified ophthalmic endpoints are warranted.

Background: Lip and oral cavity cancer is a significant global health concern, with increasing incidence rates in recent years. Understanding epidemiological trends and their associated risk factors is crucial for effective prevention and management.

Aim: This study aimed to analyze global, regional, and national trends in lip and oral cavity cancer incidence, mortality, and disability-adjusted life-years (DALYs) from 1990 to 2021 to assess key risk factors and sociodemographic influences to support clinical pharmacy interventions and improve patient outcomes.

Method: Lip and oral cavity cancer burden was analyzed by location, age, and sex. Joinpoint regression assessed trends, Spearman correlation measured sociodemographic index (SDI) associations, and decomposition analysis quantified population growth, aging, and epidemiological impacts. Cross-country disparities and risk factors were also evaluated.

Results: In 2021, there were 421,577 (95% uncertainty interval [UI]: 389,879-449,782) new lip and oral cavity cancer cases, 208,379 (95% UI: 191,288-224,162) deaths, and 5,874,070 (95% UI: 5,326,986-6,347,557) DALYs globally, with the highest burden in South Asia. The age-standardized incidence rate (ASIR) increased significantly, while the age-standardized mortality rate (ASMR) and age-standardized DALYs rate slightly declined. Men and older adults had higher rates, but the increase was more pronounced in women and younger populations. ASIR correlated positively with SDI, while cross-country inequalities persisted, particularly in low-SDI regions. The contribution of tobacco chewing to lip and oral cavity cancer deaths and DALYs slightly increased.

Conclusion: The incidence of lip and oral cavity cancer continues to increase, with a shifting burden on younger individuals and women. Targeted interventions to reduce risk factors and improve access to healthcare are essential for high-risk populations and regions.

Introduction: Adherence to biologics is crucial for the effective management of patients with inflammatory bowel disease (IBD). However, comprehensive data on the prevalence of adherence is still lacking.

Aim: This systematic review and meta-analysis aimed to estimate the prevalence of adherence to biologics among adult patients with IBD and to identify the factors influencing adherence.

Method: We conducted a systematic search of PubMed, Embase, Scopus, CINAHL, Web of Science, the Cochrane Library, and three Chinese databases for relevant observational studies published between January 1, 2010, and March 15, 2025. A random-effects model was employed to calculate the pooled prevalence of adherence. Heterogeneity and publication bias were assessed. We classified the identified influencing factors and conducted a narrative synthesis to summarize the findings.

Results: This review included 29 studies involving 44,397 patients with IBD from 14 countries. The pooled prevalence of adherence to biologics was 70% (95% CI 66%-75%, I² = 98.9%). Subgroup analyses indicated that higher adherence was likely among patients from upper-middle-income countries, those assessed with validated subjective tools, patients with CD, and those receiving subcutaneous biologics. Studies with cross-sectional designs and lower methodological quality also tended to report higher adherence. Gender and insurance status were identified as key factors influencing adherence, consistently supported by at least three studies.

Conclusion: The results suggested that adult patients with IBD exhibit moderately high levels of adherence to biologics. Gender and insurance status were factors associated with adherence. Given that these conclusions are limited by heterogeneity and methodological diversity, further validation through high-quality studies is required.

Introduction: Anti-angiogenic therapy has demonstrated therapeutic potential for several malignancies; however, its clinical efficacy in gastric cancer (GC) remains limited. To better understand the evolution of this field, comprehensive bibliometric analysis is required to map research trends, identify key contributors, and highlight emerging hotspots.

Aim: This study aimed to systematically map the research landscape of anti-angiogenic therapy for gastric cancer and identify key trends, hotspots, and emerging fronts using a bibliometric analysis.

Method: Publications related to anti-angiogenic therapy in GC were retrieved from the Science Citation Index Expanded (SCIE) and the Social Science Citation Index (SSCI) within the Web of Science Core Collection (WoSCC), covering 2000 to 2024. Microsoft Excel 365 was used to plot annual publication trends. VOSviewer was used to construct collaboration networks between countries/regions, institutions, authors, and co-cited references. CiteSpace was used to conduct keyword co-occurrence and burst analysis.

Results: In total, 916 publications were identified, comprising 698 articles and 218 reviews. The annual output increased steadily after 2003, peaking at 63 publications by 2021. China was the most productive country, followed by the USA, and both countries demonstrated a close collaborative relationship. The leading publishing institutions are primarily Chinese, including Shanghai Jiao Tong University, Nanjing Medical University, and Sun Yat-sen University. The most productive authors were Masakazu Yashiro, followed by Giuseppe Aprile, and Jin Li. The co-citation analysis identified landmark references by Fuchs (Lancet 383:31-39, 2014, 153 citations), Wilke (Lancet Oncol 15:1224-1235, 2014, 143 citations), and Ohtsu (J Clin Oncol 29:3968-3976, 2011, 133 citations) as central to the field. Keyword analysis revealed that early research has focused on "gastric cancer," "angiogenesis," and "bevacizumab." More recent hotspots shifted toward targeted therapy and clinical trial terminology, such as "first-line therapy," "randomized phase III," "supportive care," and "chemotherapy." Citation burst analysis highlighted emerging strategies, with frequent bursts for "nivolumab," "open label," and "plus chemotherapy," reflecting the integration of immunotherapy and multimodal regimens.

Conclusion: This bibliometric mapping provides a comprehensive overview of global research on anti-angiogenic therapy for GC from 2000 to 2024. These findings delineate influential contributors, evolving research priorities, and emerging therapeutic strategies, and offer valuable guidance for future basic and clinical studies in this rapidly advancing field.

Introduction: Physician burnout, marked by emotional exhaustion, depersonalization, and diminished professional efficacy, poses a significant threat to healthcare quality and workforce sustainability. Clinical pharmacists are increasingly recognized for their potential to enhance patient outcomes, reduce costs, and alleviate physician workload. Despite growing interest in embedding pharmacists within primary care teams, limited research explores pharmacists' own perspectives on their role in mitigating burnout and the conditions that support successful integration.

Aim: This study aimed to explore pharmacists' perceptions and experiences of working within primary care teams, focusing on their roles, daily activities, and the barriers and facilitators influencing integration.

Method: Using photovoice, a participatory qualitative method, six pharmacists from Tennessee Heart Health Network (TN-HHN) clinics documented their experiences through photographs and captions over four weeks. These visual narratives captured aspects of team dynamics, implementation challenges, successes, and patient-centered care. A virtual focus group followed, where participants discussed their images. The session was transcribed and analyzed using thematic coding, with respondent validation ensuring accuracy.

Results: Six pharmacists from the University of Tennessee Health Science Center's Tennessee Heart Health Network, representing four healthcare systems, participated in the study.​ Participants submitted 40 photographs, reflecting six key areas of integration. Five themes emerged: (1) Transition from skepticism to advocacy, highlighting evolving physician trust and role clarity; (2) Integration through visibility and accessibility, emphasizing relationship-building and strategic placement; (3) Role expansion from administrative tasks to clinical leadership, enabling physicians to focus on broader care; (4) Safety and quality improvements via innovation and standardization; and (5) Enhanced patient experience through education and co-visits, particularly in chronic disease management.

Conclusion: Pharmacists in primary care settings contribute significantly to team-based care, improving clinical workflows, patient outcomes, and physician well-being. Their integration fosters collaborative environments where all clinicians practice at the top of their license. Despite structural barriers such as reimbursement limitations, findings suggest that pharmacist visibility, trust-building, and role clarity are critical to successful implementation. This study underscores the value of engaging pharmacists in care teams and offers practical insights for scaling integrated models to address workforce challenges and improve care quality.

Introduction: Integrating community pharmacies into primary care via digital infrastructure is crucial to enhancing continuity, coordination, and safety of care. Historically, community pharmacies have not had full access to general practice electronic health records (EHRs), limiting their ability to provide informed interventions. The introduction of shared, interoperable EHRs has the potential to address this limitation and redefine the clinical role of community pharmacists.

Aim: This study aimed to evaluate the feasibility, acceptability, and impact of granting community pharmacies read-and-write access to a shared EHR system (SystmOne) across selected sites in the East of England.

Method: A 12-month mixed-methods pilot (Jan-Dec 2023) was conducted using an explanatory sequential and convergent approach. Data were collected from 35 community pharmacies and 31 general practices via activity logs, surveys, and semi-structured interviews. Descriptive statistics was used to analyse quantitative data and thematic coding used for analysing qualitative data. Data was then integrated to evaluate service delivery, communication, and user experience.

Results: Thirteen community pharmacies actively used the EHR, documenting over 19,000 appointments and 16,000 clinical entries. Usage varied, with barriers including workload, technical complexity, and duplicated documentation requirements. However, users reported improvements in patient safety, interprofessional communication, and service efficiency. Appointment booking and task-sharing functions fostered collaborative working, while access to real-time clinical information supported clinical decision-making. Training support, trust between sectors, and policy alignment were identified as critical enablers for system uptake.

Conclusion: Providing community pharmacies with read-and-write access to a shared EHR is feasible and contributes to safer, more integrated patient care. Improved communication, clinical documentation, and task delegation between pharmacists and general practice staff represent a major shift in digital collaboration. However, successful scale-up requires investment in interoperability, national IT infrastructure alignment, and streamlined reimbursement processes to prevent duplication of effort. These findings support the evolving clinical role of community pharmacists and suggest that integrated digital systems are essential to realising the full potential of community pharmacy in the modern NHS to improve patient care.

Introduction: Optimising medication usage is a worldwide challenge. While numerous feedback interventions have been developed to address this issue, understanding patients' perspectives on the use of such interventions to optimise adherence provides opportunities for successful development and implementation.

Aim: To synthesise qualitative evidence on patients' views on medication adherence feedback interventions to support adherence behaviour.

Method: CINAHL, EMBASE, MEDLINE, PsycINFO, and PubMed were systematically searched from database inception to February 2023 with searches updated to February 2025. Additionally, Google Scholar was used to identify any potentially relevant grey literature or supplementary sources. Eligible studies included qualitative or mixed-methods research that explored adult patients' perspectives on medication adherence feedback interventions for long-term conditions, specifically those aimed at self-management within community settings. The review was conducted according to ENTREQ and reported following PRISMA guidelines. Study quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Data were extracted and analysed using thematic synthesis, with findings presented narratively.

Results: Of the 1270 studies screened, 11 met the inclusion criteria and evaluated participants' views on therapeutic drug monitoring and digital adherence interventions across conditions including asthma, human immunodeficiency virus (HIV), coronary heart disease, hypertension, type 2 diabetes, and opioid use disorder. Three themes were identified; balancing support and autonomy in feedback interventions, maintaining patient-provider relationship and enhancing engagement through tailored design. Interventions were considered acceptable when they were easy to use, offered users control over personal data, incorporated audio-visual cues, and provided emotional or motivational support. Trust and shared decision-making between patients and providers facilitated uptake, while tailored interventions were considered essential for supporting engagement.

Conclusion: Medication adherence feedback interventions are acceptable, however further improvements will enhance user engagement and optimise adherence. Future research should prioritise co-designed interventions that address user needs, improve patient-provider communication, deliver accurate adherence feedback, and support cost-effective scalability.