International Journal of Pharmacy Practice最新文献

Objectives: Continuous subcutaneous infusions (CSCIs) are indicated as an alternative therapy when the oral route is not viable. However, despite their widespread use in palliative care, the evidence for admixture compatibility remains a limitation. It is estimated that a significant number of admixtures used in practice are not supported by laboratory studies, which may lead to suboptimal clinical outcomes. The study aimed to determine the frequency of admixtures used in clinical practice without compatibility data generated by laboratory studies, and thereby identifying the most commonly prescribed admixtures that require laboratory data, which can help to guide the prioritization of future testing.

Methods: This study was conducted across five palliative care services (three inpatients and two communities) in Victoria, Australia between May and July 2021. Electronic or paper medication charts of CSCIs were reviewed across all participating sites for all infusions administered. Data collected included medication combinations, dose, diluent, final volume, duration of infusion, reports of infusion-related reactions, and observed incompatibility.

Key findings: A total of 616 infusions containing two to three medications were assessed. Only 60% of these infusions were validated by laboratory data. Eleven most commonly prescribed admixtures with no laboratory compatibility data were identified over the 3-month period.

Conclusion: Laboratory testing for the identified admixtures should be advocated to promote the safe and effective use of these medications.

Objectives: To evaluate human-based Medical Subject Headings (MeSH) allocation in articles about 'patient simulation'-a technique that mimics real-life patient scenarios with controlled patient responses.

Methods: A validation set of articles indexed before the Medical Text Indexer-Auto implementation (in 2019) was created with 150 combinations potentially referring to 'patient simulation'. Articles were classified into four categories of simulation studies. Allocation of seven MeSH terms (Simulation Training, Patient Simulation, High Fidelity Simulation Training, Computer Simulation, Patient-Specific Modelling, Virtual Reality, and Virtual Reality Exposure Therapy) was investigated. Accuracy metrics (sensitivity, precision, or positive predictive value) were calculated for each category of studies.

Key findings: A set of 7213 articles was obtained from 53 different word combinations, with 2634 excluded as irrelevant. 'Simulated patient' and 'standardized/standardized patient' were the most used terms. The 4579 included articles, published in 1044 different journals, were classified into: 'Machine/Automation' (8.6%), 'Education' (75.9%) and 'Practice audit' (11.4%); 4.1% were 'Unclear'. Articles were indexed with a median of 10 MeSH (IQR 8-13); however, 45.5% were not indexed with any of the seven MeSH terms. Patient Simulation was the most prevalent MeSH (24.0%). Automation articles were more associated with Computer Simulation MeSH (sensitivity = 54.5%; precision = 25.1%), while Education articles were associated with Patient Simulation MeSH (sensitivity = 40.2%; precision = 80.9%). Practice audit articles were also polarized to Patient Simulation MeSH (sensitivity = 34.6%; precision = 10.5%).

Conclusions: Inconsistent use of free-text words related to patient simulation was observed, as well as inaccuracies in human-based MeSH assignments. These limitations can compromise relevant literature retrieval to support evidence synthesis exercises.

Objectives: To determine the prevalence of heart failure (HF) medication prescribing on discharge post-HF-related admission.

Methods: A retrospective audit was conducted for 216 HF admissions over a period of 6 months; medication data from electronic records were collected for analysis.

Key findings: The prevalence of HF medication prescribing on discharge was: 32.9% (95% confidence interval: 26.6-39.6) renin-angiotensin-aldosterone system inhibitors, 10.6% (6.9-15.6) angiotensin receptor-neprilysin inhibitors, 31.5% (25.4-38.1) HF-specific beta-blockers, 42.6% (35.9-49.5) aldosterone receptor antagonists, and 11.6% (7.6-16.6) sodium-glucose cotransporter-2 inhibitors.

Conclusion: HF medication prescribing remains relatively low despite the known benefits and recommendations listed in the guidelines.

Objective: Pharmacist-led research is key to optimizing medicines use and improving pharmacy services, yet it is not yet widely embedded into careers. This study aims to identify predictors of confidence in meeting the research learning outcomes in the Royal Pharmaceutical Society (RPS) Post-Registration Foundation and Core Advanced curricula, to provide targeted recommendations for building research capability and capacity within the profession.

Methods: The study was a cross-sectional electronic survey, distributed to eligible pharmacists in March 2023 (n = 253). The survey gathered demographic information, research experience, and self-reported confidence in meeting the research learning outcomes in the RPS Post-Registration Foundation and Core Advanced curricula. Pre-determined independent variables were analysed using two binomial logistic regression models (one per curriculum) to identify predictors of the dichotomous variable: confidence with meeting all research learning outcomes in that curriculum.

Key findings: Participants were more likely to self-report as confident (versus not confident) with meeting all research learning outcomes in a curriculum if they had recent experience (within the previous 12 months) of research or research-related activities, held a postgraduate research qualification, had undertaken research training outside of a postgraduate qualification, discussed research in their appraisal, or worked in the hospital sector. Conversely, male gender, years practicing, and protected time for research did not predict confidence.

Conclusion: A targeted approach, including improving access to research methods training, experience-based learning, mentorship, and linking research projects to key organizational objectives, could be the key to developing research capability and capacity across all sectors and career stages.

Objectives: Adverse drug reactions (ADRs) are a major drug safety concern and a frequent topic of enquiries to hospital drug information services. Our goal was to analyse these enquiries regarding background, complexity, nature of ADR, and involved drug classes to improve in-hospital drug safety.

Methods: Retrospectively, ADR enquiries to a German university hospital pharmacy drug information 2018-2022 were analysed regarding enquirer (profession, medical specialty) and enquiry details (drugs, suspected ADR/enquiry prior to drug initiation, ADR system organ class, probable cause identified, and enquiry complexity).

Key findings: Of 543 enquiries, 516 (95%) were asked by physicians, 493 (91%) patient-specific, 390 (71%) on suspected ADRs, and 153 (28%) prior to drug initiation. Enquiries originated frequently from internal medicine (74/13.6%), paediatrics (71/13.1%), neurology (70/12.9%), and haemato-oncology (62/11.4%). Most frequent ADRs were haematologic (94/17%) and hepatic (72/13%). The median number of drugs per enquiry was three (range 0-37), 209 (38%) enquiries referred to one specific drug, 165 (30%) concerned ≥11 drugs. A probable cause for suspected ADRs was identified in 75 (36%) enquiries concerning one drug and 155 (94%) with ≥11 drugs. Most frequent drugs were antineoplastic (54/25.8%), nervous-system-drugs (42/20.1%), and anti-infective (40/19.1%). Most enquiries (342/63%) were complex (multiple/specialist resources).

Conclusions: Enquiries were usually asked by physicians referring to suspected ADRs in specific clinical situations. A probable cause was identified in many cases pointing to a direct positive impact on patient care. Enquiries prior to drug initiation should be encouraged to increase drug safety. Information on main ADR effects and drug classes helps with targeted counselling.

Objectives: Previous studies have examined the psychological burden of caregivers of patients with dementia. However, although many caregivers struggle to assist patients with dementia with medication management, the relationship between assisting such patients with taking their medicines and the caregiver psychological burden is understudied. Therefore, this study identified the association between caregivers' psychological burden and assisting patients with dementia with taking medication.

Methods: A cross-sectional survey was conducted among caregivers of patients with dementia in Japan. The survey questionnaire included questions that assessed the symptoms of patients with dementia, their status of taking medication through medication assistance from caregivers, and caregivers' psychological burden using the Kessler Psychological Distress Scale and the Japanese version of the Perceived Stress Scale.

Key findings: A total of 57 caregivers participated in the study. Higher Kessler Psychological Distress Scale scores were significantly associated with unsuccessful assistance with taking regular medication (β = 0.35, 95% confidence interval [CI]: 2.23-12.0, P < .05), depressive symptoms (β = 0.26, 95% CI: 0.10-8.53, P < .05), and irritability (β = 0.38, 95% CI: 2.71-11.5, P < .05). Likewise, higher scores on the Japanese version of the Perceived Stress Scale were significantly associated with irritability (β = 0.37, 95% CI: 1.87-12.5, P < .05) among patients with dementia.

Conclusion: The findings suggest that caregiver psychological burden is associated with unsuccessful assistance with taking regular medication for patients with dementia.

Objectives: Nonpharmacy outlets are common medication suppliers in Indonesia, yet little is known regarding their practices. This study aimed to evaluate the medication selling practices occurring in kiosks and minimarkets during the coronavirus disease 2019 pandemic.

Methods: A cross-sectional study included all minimarkets (N = 101) and a convenience sample of kiosks (a minimum sample size, N = 67) in District X, Indonesia. A validated tool was used to collect data on the characteristics of kiosks/minimarkets and their medication selling practices (i.e. drug management and drug information).

Key findings: A sample of 67 kiosks and 52 minimarkets (response rate 51.5%) consented to participate in this study. Kiosks and minimarkets generally stocked nonprescription drugs, particularly cough and/or common cold products or analgesic-antipyretics; while >90% of kiosks and 15.4% of minimarkets provided prescription medicines. Medications in kiosks and minimarkets were mainly obtained from pharmacies (94.0% vs. 17.0%, respectively) or pharmaceutical wholesale representatives (68.7% vs. 96.0%, respectively). Most minimarkets or kiosks satisfied drug storage standards (100.0% vs. 88.1%, respectively). During the previous week, >80% of kiosks and minimarkets reported purchases of nonprescription drugs, and approximately 5% reported sales of prescription drugs. No drug information was provided by kiosk or minimarket staff.

Conclusions: Minimarkets and kiosks may improve access to basic medications, but no information is provided regarding their use. These outlets should be licensed and policed to ensure the range and quality of drugs, and information provided to the Indonesian community is appropriate.

Objective: To describe the resident pharmacist's participation in Shared Medical Appointments (SMA) in palliative care.

Methods: The resident pharmacist participated in face-to-face SMA with the attending physician, medical and gerontology students, and a nurse.

Key findings: The resident pharmacist supported interdisciplinary discussions and performed pharmaceutical interventions. He helped raise awareness about the effective, safe, and convenient use of medicines, helping improve the quality of life of patients and caregivers.

Conclusions: Providing pharmaceutical care to patients in palliative care helped to improve the quality of clinical services offered to these patients, as well as adding value to resident pharmacists' interprofessional practice.

Objectives: Incorrect labelling of a penicillin allergy can lead to unnecessary use of broad-spectrum, less effective, more harmful, or more costly antibiotics. Community pharmacists are well positioned to educate the public on penicillin allergies, prevent incorrect labelling persisting, and optimize prescribing of antibiotics. This study investigated community pharmacists' capacity to recognize an opportunity to directly de-label a no-risk penicillin allergy.

Methods: A sequential explanatory mixed methods design using mystery shopping (quantitative) and postvisit reflections (qualitative). Mystery shoppers simulated a case of a previously dispensed prescription (involving nonimmune mediated intolerance 'thrush' as the reported allergy) that provided the opportunity for pharmacists to educate on incorrect penicillin allergy. The main outcomes were proportion of community pharmacists who ascertained the nature of the penicillin reaction, provided education on incorrect penicillin allergy labels and its consequences. Knowledge and practices regarding penicillin allergy were collected.

Key findings: Across two major states in Australia, 265 community pharmacists participated. Only 44.5% (118/265) of pharmacists asked about the nature of the reaction; of those, 91.52% (108/118) indicated that 'thrush' is not an allergic reaction. No pharmacists took the opportunity to educate on how an incorrect allergy label can impact antibiotic prescribing. Postvisit reflection data revealed five probable explanations for the observations viz. outdated knowledge, lack of knowledge, prioritizing management of adverse drug reaction (thrush), variations in duty of care and assumption of true allergy without an assessment.

Conclusion: Our findings underscore a concerning knowledge and practice gap among community pharmacists regarding penicillin allergy assessment which warrants more support and education in the community pharmacy sector.