Clinical pharmacy services comprise a range of patient-centered, systematic care activities delivered by pharmacists, aiming to optimize medication use and improve patient outcomes. Despite growing recognition of the role of clinical pharmacy in medication safety, there is limited comprehensive analysis of barriers or actionable strategies, especially in under-resourced areas. This study aims to explore the state of implementation of clinical pharmacy practice, to elucidate the influencing factors and associated strategies.
Data were collected through quantitative surveys, participant observation, and semi-structured interviews. Data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR). Directed content analysis was used to code the data and identify factors influencing clinical pharmacy services. Implementation strategies were developed using the CFIR-ERIC matching tool.
Case studies were conducted in six county hospitals, with a total of 64 interviewees. We identified 25 facilitators and 21 barriers across five CFIR domains, with 15 distinguishing constructs between well and poorly performing centers. Our findings highlighted the critical role of local condition, policies and laws, external support, standardized appraisal systems, leadership, available resources, staffing and performance-linked incentives in sustaining service quality. Our analysis also proposed 8 tailored strategies to support sustainable implementation. The main distinguishing constructs between well and poorly performing implementation centers included outer setting, inner setting, individuals and implementation process.
The implementation and sustainability of clinical pharmacy services are still limited by factors such as inadequate resources, inappropriate regulatory frameworks, lack of leadership, and insufficient competency of pharmacists. Corresponding implementation strategies should be adopted to promote the development of clinical pharmacy services, and the professional development of clinical pharmacists, especially in under-resourced areas.
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Ecological anxiety related to climate change is thought to be a risk factor for premenstrual syndrome (PMS). Regular physical activity can effectively reduce both physical and psychological symptoms associated with PMS. This study was conducted to examine the moderating effect of physical activity on the relationship between climate change-related eco-anxiety and PMS.
This cross-sectional and correlational study was conducted between February and March 2025 on 635 female students studying in health-related departments of a university. Personal information form, PMS scale, eco-anxiety scale and International Physical Activity Questionnaire-Short form were used to collect data.
The prevalence of PMS was 87.7% and the median score on the Eco-anxiety scale was 13. The direct effect of eco-anxiety on PMS was positive and statistically significant (β = 0.606, p < 0.001). The direct effect of physical activity on PMS was negative and statistically significant (β = −0.067, p = 0.029).
The results of this study suggest that eco-anxiety levels affect PMS symptoms and that physical activity has a modulatory effect on the relationship between eco-anxiety and PMS. Psychosocial interventions aimed at reducing eco-anxiety and lifestyle changes that promote physical activity should be considered in interventions to manage premenstrual syndrome. It is important that women's health nurses and midwives, who have an important role in protecting and promoting women's health, consider eco-anxiety in their interventions.
Mental health disorders are widely recognised as significant challenges for university students globally. Participation in extracurricular activities has been associated with reduced psychological stress and improved overall well-being among university students.
This study aims to investigate whether participation in extracurricular activities has a measurable impact on depression, anxiety, and stress among pharmacy students at King Khalid University.
A cross-sectional study was conducted among 220 pharmacy students. Data encompassed demographics, DASS-21 scores, prior mental health diagnoses, and detailed participation in extracurricular activities (type, frequency, hours per week). Analytical methods included t-tests, ANOVA, regression modelling.
Clinically significant symptoms were common: 38% depression, 52% anxiety, 35% stress. While 79% reported extracurricular involvement (primarily volunteering, social, cultural, and sports activities), no statistically significant difference in DASS-21 scores between participants and non-participants (p > 0.05 for all subscales). Even the type and frequency of activities failed to confer a meaningful protective effect. Female gender and prior mental health diagnoses emerged as the strongest, independent predictors of higher psychological distress.
Involvement in the extracurricular activities, as currently structured, does not significantly impact depression, anxiety, or stress scores among pharmacy students at King Khalid University. Despite widespread participation, high psychological distress persists, especially among female students and those with prior diagnoses. These findings suggest the need for targeted, quality-focused mental health interventions beyond simply encouraging extracurricular activity.
This meta-research study mapped systematic reviews on photobiomodulation (PBM), encompassing low-level laser therapy (LLLT) and light-emitting diode (LED) modalities, to evaluate whether protocols were registered, whether published reviews adhered to and updated their PROSPERO records, and whether topic redundancy occurred across reviews.
Comprehensive searches were conducted in MEDLINE (via PubMed) and Epistemonikos on June 2, 2025. Data were extracted on protocol registration, registry type, update status on PROSPERO, deviations between registered protocols and published reviews, topic redundancy, and the use of certainty of evidence assessment tools.
A total of 285 systematic reviews (with and without meta-analysis) published between 1999 and 2025 were included, of which approximately 40% addressed dentistry and orofacial dysfunctions. Among these, 129 reviews (45%) had a registered protocol, with 125 (96.9%) on the PROSPERO platform and four (3.1%) on other registries, including INPLASY and the Open Science Framework. Despite publication, 72% (90/125) of PROSPERO records remained classified as “ongoing,” reflecting limited updates to the registry status. Deviations between registered and published protocols occurred in 22.4% (29/129) of reviews, mainly involving unplanned outcomes, modifications in search strategies, or changes in analytical methods. Redundancy was frequent, with multiple reviews addressing identical or highly similar clinical questions, such as 20 reviews on orthodontic treatment and 18 on temporomandibular dysfunction. Assessment of the certainty of the evidence was also limited, with only 18.5% (53/285) of reviews applying the GRADE approach, which was reported exclusively in reviews with meta-analysis.
These findings highlight low adherence to protocol registration recommendations, limited status updating, and high levels of duplication, combined with infrequent assessment of evidence certainty. Strengthening prospective registration and transparent reporting is essential to ensure that systematic reviews on PBM provide trustworthy, reproducible evidence to guide clinical decision-making and inform healthcare policy. The study protocol is available at https://osf.io/9vknf/.
Epidermolysis bullosa is a rare genetic disorder causing extreme mucocutaneous fragility, requiring specialized, multidisciplinary care. Integrating palliative care into Epidermolysis bullosa management has proven beneficial in symptom control and psychosocial support. The aim of this study was to analyze the interdisciplinary intervention of the Dermatology Service and the Palliative Care and Complex Chronic Patient Team at Sant Joan de Déu Hospital in pediatric patients with Recessive Dystrophic Epidermolysis Bullosa.
A descriptive qualitative design was used to explore the experiences of parents of children with Recessive Dystrophic Epidermolysis Bullosa and healthcare professionals at Sant Joan de Déu Hospital. Internal protocols were analyzed and open online surveys were conducted. Families were recruited through purposive sampling with DEBRA España's support, while healthcare professionals were invited from the Dermatology Service and the Palliative Care and Complex Chronic Patient Team.
The joint interdisciplinary intervention between the Dermatology Service and the Palliative Care and Complex Chronic Patient Team at SJDH, grounded in a palliative care approach, provides holistic and continuous support to patients and their families from birth throughout the entire life course. It incorporates spiritual care and community coordination, fosters autonomy and social inclusion, and aligns with international best practices established by specialized centers such as EB House Austria. This model stands as a replicable benchmark for the care of individuals with EB.
This qualitative study suggests that an interdisciplinary care model, grounded in palliative care and implemented from an early stage in a sustained manner, improves the quality of life of pediatric patients with RDEB and their families. The coordination between clinical and psychosocial teams, together with person-centered care, enhances family autonomy, promotes inclusion and addresses the comprehensive needs across the life course.
The study aimed to explore how dentists in different countries prioritize strategies to address the evidence–practice gap (EPG). The objectives were to (1) evaluate and compare the priority of strategies to improve the evidence-practice gap (EPG) among Japanese and Brazilian dentists, and (2) analyze the association between the self-reported EPG and improvement strategies.
A cross-sectional study with two rounds of web-based questionnaires was administered to 136 dentists in Japan and 110 in Brazil. The self-reported EPG was assessed using three items related to minimal intervention dentistry (MID) via a mixed-methods approach with qualitative and quantitative assessments. Participants quantitatively prioritized EPG improvement strategies based on items derived from a qualitative content analysis. Logistic regression examined the association between the self-reported EPG and these stated improvement strategies.
Seven EPG improvement strategies were identified from the qualitative content analysis. The highest priority selected by dentists in Japan was ‘Review the insurance system and reimbursement to enable the practice of evidence-based dentistry’ (65%). In Brazil, the highest priority was ‘Encourage dental research that is useful to clinical practice and disseminate its findings’ (74%). The second-highest priority in both countries was ‘Enhance continuing education programs to enable dentists to practice evidence-based dentistry’ (49% in Japan and 65% in Brazil). Logistic regression showed that in Japan, ‘Review the insurance system and reimbursement to enable the practice of evidence-based dentistry’ and in Brazil, ‘Develop and disseminate easy-to-understand clinical practice guidelines’ were significantly associated with the self-reported EPG among these same respondents (p < 0.05).
This mixed-methods study identified seven strategies to improve the EPG in Japan and Brazil. Improving the insurance system and reimbursement in Japan, and developing and disseminating clear clinical practice guidelines in Brazil, may effectively bridge the EPG. Enhancing continuing education was the second-highest priority in both countries.
Even given identical information, patients and healthcare professionals may appropriately make conflicting decisions.
Introduce the concept of mutual two-person, as opposed to individual, decision making.
Present operational definition of shared decision making based on two-person decision theory demonstrate how to identify a shared decision, distinguish between a shared decision and some other commonly used approaches, and report the results of computer simulations that demonstrate the patterns of mutual satisfaction of various decision approached given common information.
Shared decision making yields more mutually stable and satisfactory treatment decisions than do other approaches and have the additional advantage of achieving fewer morally questionable outcomes.
In addition to shared information, shared decisions are superior to those made independently by patients or healthcare professionals.
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