Pharmacy Practice is a full-text peer-reviewed journal with a scope on pharmacy practice. Pharmacy Practice is published quarterly.
Assessing knowledge of village health volunteers on pharmaceutical consumer protection and unsafe health products in Thailand
Background: Village health volunteers (VHVs) are pivotal to Thailand’s primary care and increasingly engage in pharmaceutical consumer protection; however, evidence linking their knowledge to role perception and personal factors is limited. Objective: To measure VHVs’ knowledge of health consumer protection, examine associations with personal and role-related factors, and inform targeted training and policy. Methods: Cross-sectional census of active VHVs in Ko Chan District, Chonburi (n=270). A validated questionnaire captured demographics, role perception, and a 10-item knowledge test (0–10; also categorized). Descriptive statistics, group comparisons, Pearson/Spearman correlations, and multivariable logistic regression (outcome: high knowledge ≥80%) were applied (α=0.05). Results: Mean knowledge was 6.71±0.92 (median 7, IQR 6–7); mean role perception was 37.13±4.92 (median 36, IQR 34–41). Correlations between role perception and knowledge were non-significant (Pearson r=0.027, p=0.664; Spearman ρ=0.073, p=0.232). Logistic regression identified no independent predictors of high knowledge: role perception AOR 0.956 (95% CI 0.873–1.047; p=0.337); prior training AOR 0.691 (0.271–1.758; p=0.437); years of service and other demographics also non-significant, with some subgroup estimates imprecise due to sparsity. Conclusions: VHVs demonstrated moderate knowledge with limited variability and no detectable effects of role perception, training, or service duration. Findings support universal, competency-based refresher training and structured CPD aligned with pharmacy-practice priorities (e.g., recognition/reporting of substandard/falsified products) to strengthen community-level pharmaceutical safety.
Integration of community pharmacy in primary health care
Copyright (c) 2026 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/
Pharmacist-led evaluation of a novel nail-cutting innovation versus conventional trimming in hemiplegic patients: A Randomized controlled trial
Background: Hemiplegic patients often have trouble maintaining nail hygiene due to unilateral hand dysfunction, increasing the risk of perionychial injury, infection, and reduced quality of life. Assistive devices enabling safe, independent nail trimming may address these challenges while supporting preventive health strategies. Objective: To evaluate the efficacy and safety of a novel one-handed, electrically powered nail-cutting device compared with conventional manual clippers in hemiplegic patients. Methods: A randomized controlled trial was conducted at Naresuan University Hospital in two phases: preliminary testing in healthy volunteers (n=10) and clinical evaluation in hemiplegic patients (n=20). Participants were randomized to use either the novel device or conventional clippers. Primary outcomes were trimming quality (shape uniformity, smoothness of edges) and safety (incidence of perionychial injury, pain scores). Secondary outcomes included user satisfaction and completion time. Randomization, independent allocation, standardized training, and blinded outcome assessment were employed to enhance internal validity. Results: In hemiplegic patients, the novel device achieved smoother nail edges, preserved nail integrity, and significantly reduced pain compared with conventional clippers (mean difference in pain score: –0.68; 95% CI: –1.28 to –0.08). No perionychial injuries occurred in the intervention group. Satisfaction scores were consistently high, with participants reporting enhanced self-esteem and perceived safety. Similar performance and safety were observed in healthy volunteers. Conclusion: The novel one-handed electric nailcutting device demonstrated superior efficacy, safety, and user satisfaction compared with conventional clippers in hemiplegic patients. While findings are promising, larger multi-center trials with longer follow-up are warranted to confirm these results and assess cost-effectiveness and long-term adherence.
Reducing outpatient drug-related problems through pharmacist led interventions: A multi-center interventional study in provincial hospitals in Vietnam
Background: Drug-related problems (DRPs) significantly affect patient safety, clinical outcomes, and healthcare efficiency. Pharmacist-led interventions have demonstrated potential in improving prescribing practices, yet limited data exist on their effectiveness in outpatient settings in Vietnam. This study evaluated the impact of structured pharmacist interventions on reducing DRPs in outpatient prescriptions at multiple healthcare facilities in a province in Vietnam. Methods: A pre-post interventional study was conducted at three hospitals in a province in Vietnam. Pharmacists systematically reviewed outpatient prescriptions identified DRPs using version v9.1 of the Pharmaceutical Care Network Europe (PCNE) classification and selected criteria from Vietnam’s Ministry of Health classification, and provided structured interventions, including quarterly seminars, hospital DRP bulletins, and personalized physician-specific DRP information sheets. Multivariate logistic regression assessed factors associated with DRP. Results: In total, 4,070 prescriptions preintervention and 4,051 prescriptions post-intervention were analyzed. Pharmacist-led interventions significantly reduced the proportion of prescriptions with at least one DRP from 21.7% (pre-intervention) to 9.1% (post-intervention; p<0.001). Significant reductions were observed across multiple DRP categories, including inappropriate drug indications, contraindicated medications, unnecessary drug prescriptions, incorrect dosing, improper timing of administration, and clinically significant drug-drug interactions (p<0.001). Factors independently associated with higher DRP risk included patient age ≥60 years (OR=1.554; p<0.001) and prescriptions containing five or more medications (OR=2.435; p<0.001). Proton pump inhibitors, gastrointestinal motility regulators, and non-steroidal anti-inflammatory drugs (NSAIDs) were most frequently implicated in DRPs. Conclusions: Pharmacist-led interventions effectively reduced DRPs in outpatient prescriptions at provincial hospitals in Vietnam. Older patients and those receiving polypharmacy were at higher risk, highlighting the need for targeted pharmaceutical care. This intervention model is practical, scalable, and well-suited for integration into electronic prescribing systems, significantly enhancing medication safety and prescribing quality.
Willingness to pay for extended community pharmacy services among general public in the United Arab Emirates
The study examined individuals’ willingness to pay for extended community pharmacy services (ECPS) in the United Arab Emirates (UAE). Data was collected from all seven emirates in the UAE through an online descriptive cross-sectional survey which was conducted in March and May 2021. A stratified random sample of 406 respondents participated, 71.43% were females and 28.57% males from different socioeconomic backgrounds. While SPSS was used to analyze respondents’ feedback, descriptive statistics were utilized to examine the sample’s sociodemographic features, views and readiness to pay for services. Using regression analysis, the researcher determined the link between consumers’ sociodemographic attributes and their perceptions of pharmacies and pharmacists and their willingness to pay for extended community services. The findings show that individuals purchase prescription drugs (68.97%), while others buy pharmaceutical products (59.36%) and non-prescription medications (54.43%). Proximity to pharmacies (82.51%) is the main factor influencing people’s choices. Most individuals in the UAE are confident that pharmacists have sufficient knowledge of medications and are concerned about public well-being (55.17%). Willingness to pay extended community services depends on pharmacists’ professionalism and honesty (77.83%), expertise on medication and illnesses (79.06%), and communication skills (57.39%).
Evaluating community pharmacists’ dispensing and counseling practices of semaglutide for weight loss in the United Arab Emirates: A simulated patient study
Background: The rising global prevalence of obesity has led to increased demand for medications such as Semaglutide (Ozempic®), which is approved for the treatment of type 2 diabetes. However, its off-label use for weight loss has raised international concerns regarding misuse, patient safety, and pharmacist accountability. Objectives: This study aimed to assess whether community pharmacists in the UAE dispense Ozempic® without a valid prescription and to evaluate the quality and comprehensiveness of pharmacists’ screening and counseling regarding Ozempic®. Methods: A cross-sectional study was conducted using the simulated patient (SP) methodology. A trained SP visited 153 randomly selected community pharmacies across Dubai and the Northern Emirates and requested Ozempic® without a prescription for weight loss. Data was collected using a structured checklist covering prescription requirements, screening practices, and counseling quality. Results: Of the 153 pharmacies visited, only a minority (26.8%) requested a prescription for Ozempic® before dispensing the medication. Chain pharmacies (35.4%) and female pharmacists (38.6%) were significantly more likely to request a prescription (p = 0.011 and p = 0.004). Additionally, when comparing the total percentage of pharmacists willing to dispense the medication without a prescription to a hypothetical benchmark of 50%, the difference was statistically significant (p<0.001). Screening practices were minimal, with only 3–30% of pharmacists inquiring about basic patient information. Counselling quality was generally low, with 27% of visits receiving no counselling. Male pharmacists had significantly higher counselling scores than female pharmacists (p = 0.024). Time spent in the pharmacy was significantly correlated with better counselling (p < 0.001). In 20.3% of visits, alternatives, such as Tirzepatide or herbal weight loss products, were suggested. Conclusion: The study revealed significant gaps in prescription compliance and patient counseling among UAE community pharmacists when dispensing Ozempic®. These findings reflect broader global concerns about off-label medication use and the critical role of pharmacists in ensuring safe access to high-demand therapies.
Prescribing pattern, appropriateness, and factors influencing medication use in heart failure patients with reduced ejection fraction at a private tertiary hospital in Malaysia
Background: Heart Failure with Reduced Ejection Fraction (HFrEF) is a prevalent and serious medical condition worldwide. It affects millions of people and contributes significantly to morbidity and mortality. Inappropriate use of the medications may lead to adverse health outcomes and treatment failure. Objectives: This study aimed to assess prescribing patterns, the prevalence of potentially inappropriate medications (PIMs), the proportion of patients receiving the target guideline-directed medical therapy (GDMT) dose, and factors associated with suboptimal dosing in patients with HFrEF at a private tertiary care hospital in Malaysia. Methodology: This retrospective observational study involved 118 Malaysian adult patients with HFrEF who attended at least two outpatient cardiology appointments at the study hospital. The study reviewed prescriptions to identify drug prescribing patterns, GDMT use, target dose attainment, and prescribing of PIM. Results: The cohort was primarily comprised of Chinese individuals (84.80%) and males (78.80%), with a mean age of 58.7 years. The majority of patients (51.70%) received a combination of three GDMT drugs. Only 23.70% of patients were prescribed all four GDMT drugs, with 82.14% of these patients achieving at least one drug at the target dose. The prescribing rates of Renin-Angiotensin-Aldosterone System (RAAS) inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and Sodium-Glucose Cotransporter-2 (SGLT-2) inhibitors were 98.31%, 72.97%, 48.31%, and 78.81%, respectively. The attainment of target doses was low, with only 11.21% reaching the target for RAAS inhibitors, 2.32% for beta-blockers, and 1.89% for MRAs. The study indicated no significant association between target dose attainment and clinical factors, except for betablockers in atrial fibrillation and SGLT-2 inhibitors in diabetes mellitus. Additionally, 4.24% of patients were prescribed PIM. Conclusion: Both adequate prescribing rates and target dose attainment of GDMT remain challenging in clinical practice, underscoring the need for strategies to improve adherence and enhance patient outcomes.
Confidence and perceptions toward deprescribing among PharmD students in Saudi Arabian Universities
Background: Deprescribing is an essential patient safety process that remains underrepresented in pharmacy curricula. While many students may hold favorable perceptions toward deprescribing, their confidence in applying it in practice is often limited. In Saudi Arabia, there is limited data on the perceptions and confidence of PharmD students regarding deprescribing. Objective: To evaluate the confidence, perception, and educational exposure toward deprescribing among Saudi PharmD students across all professional years. Methods: A national cross-sectional survey was distributed using a convenience sampling approach. The instrument included demographic variables and two validated Likert scales measuring deprescribing confidence (5 items) and perception (8 items). Descriptive and multivariate analyses were conducted to investigate predictors of confidence and willingness to participate in deprescribing training. Results: A total of 253 PharmD students completed the questionnaire. While 70% were familiar with the concept of deprescribing, confidence remained moderate overall (mean: 3.26 ± 1.05), despite high perception scores (3.92 ± 1.05). Confidence increased significantly from P3 to P4 (2.62 vs. 3.73; p < 0.001). Multivariable analysis showed that confidence was the sole independent predictor of workshop enrollment (AOR = 0.66; 95% CI: 0.44–0.98; p = 0.04), even after adjusting for course exposure and perception. Conclusion: Although Saudi PharmD students have a positive perception of deprescribing, their confidence and intention to implement it in practice are lacking. A common trend observed in international research is that deprescribing is neither introduced early enough nor discussed frequently enough in pharmacy school curricula. National educational leaders are urged to integrate deprescribing competencies into core curricular frameworks, particularly within geriatrics and interprofessional learning, to align students’ perceptions with their practical application.
Evaluation of Pharmacists’ Confidence, Engagement, and Knowledge about Dietary Supplements in the United Arab Emirates
Background: Dietary supplements (DS) are widely used, often without prescriptions, making community pharmacists key sources of guidance. In the UAE, DS use is growing due to cultural and health trends, but pharmacists’ knowledge, confidence, and involvement with DS vary, which may impact patient safety and counselling quality. Despite their important role, there’s limited research on how well UAE pharmacists are prepared to address DS-related questions, including effects, side effects, and interactions. Objectives: The aim of this study was to evaluate the confidence, involvement, and knowledge of community pharmacists in the UAE regarding dietary supplements. Methods: This cross-sectional study utilized a self-administered questionnaire designed to fulfil the study’s objectives. The questionnaire was divided into four sections: the first collected demographic information; the second assessed pharmacists’ confidence using a confidence scale; the third examined their engagement with dietary supplements (DS’s); and the fourth evaluated their knowledge of DS’s. A total of 333 practicing community pharmacists from across the UAE participated, with the sample size calculated using Raosoft software. A simple random sampling method was employed to ensure equal representation from all emirates. Results: A total of 333 responses were obtained. The average confidence of the respondents is found to be 9.961±3.53, indicating a significantly high confidence as the total confidence ranges from 0-15, with Cronbach’s alpha reaching 0.81. The total engagement score was found to be 3.96 ±1.2, overall reliability of questions according to Cronbach’s alpha is 0.48. The average knowledge of the respondents is 12.58 (0 to 21), indicating moderate knowledge of effects and interactions. the average of confidence and knowledge of pharmacists had no significant difference in terms of demographical variables such as age, academic degree, nationality, year of graduation, however, there was a statistically significant difference in terms of emirates’ knowledge (p<0.001). Conclusion: In conclusion, community pharmacists in the UAE demonstrate high confidence, positive engagement, and moderate overall knowledge regarding dietary supplements, but show limited understanding of their side effects and interactions. To address this gap, integrating reliable information sources into pharmacy computer systems is essential. Providing pharmacists with accurate and accessible information on dietary supplements is crucial for enhancing their ability to offer safe and informed guidance to patients.
Integrating metabolomics into obesity care: towards biomarker guided pharmacy practice
Background: Obesity is a complex and prevalent global health issue strongly associated with chronic diseases. Early diagnosis and precise monitoring remain challenging due to the complex metabolic dysregulation underlying obesity. Metabolomics provides a powerful tool to investigate biochemical changes and discover novel diagnostic biomarkers. Objectives: This study used untargeted metabolomics of human plasma samples to identify distinct plasma metabolite profiles and altered metabolic pathways in overweight and obese individuals. The ultimate goal is to improve obesity management through early diagnosis and personalized treatments. Methods: A total of 74 Jordanian participants were recruited and categorized into normal-weight (n=29), overweight (n=17), and obese (n=28) groups based on BMI and metabolic parameters. Plasma samples were analyzed using ultra-high-performance liquid chromatography coupled with electrospray ionization quadrupole time-of-flight mass spectrometry (UHPLC-ESI-QTOF-MS). Data processing and statistical analysis were performed using MetaboScape and MetaboAnalyst 5.0. Group comparisons were evaluated using t-tests, ANOVA, and multivariate models, and pathway enrichment analysis was conducted to determine altered metabolic pathways. Results: A total of 82 metabolites were identified, with 26 showing significant differences between groups. In the overweight group, pantothenic acid and L-proline were elevated, while phenylacetaldehyde and glycerophosphocholine were decreased. The obese group exhibited increased levels of L-leucine, L-tryptophan, phenylalanine, and tyrosine, and reduced levels of 2,3-diaminopropionic acid and phenylacetaldehyde. Key altered pathways included pantothenate and CoA biosynthesis, beta-alanine metabolism, phenylalanine and tyrosine metabolism, and beta-oxidation of long-chain fatty acids. Conclusions: The study revealed significant novel metabolic disturbances associated with overweight and obesity, highlighting potential diagnostic biomarkers and perturbed metabolic pathways. These findings provide valuable insights into the molecular underpinnings of obesity, underscore the potential of metabolomics in advancing personalized approaches for managing obesity, and warrant further validation in larger, diverse populations to assess their diagnostic and clinical relevance.
Discordance in renal function estimates between different equations: impact on treatment and safety in critically ill patients – A retrospective study
Background: Optimizing antibiotic dosages in critically ill patients is challenging. There are several equations to estimate the estimating renal clearance. The combined creatinine and cystatin C equation revealed significant discordance in dosing when compared with creatinine-based equations. Currently, there are no published studies on the impact of discordant antibiotic dosing rates on clinical outcomes in critically ill patients. Objective: This study evaluated the treatment and safety outcomes between groups with discordance and concordance regarding overall antibiotic dosing adjustments based on the Cockcroft-Gault (CG) and the CKD-EPI eGFRcr-cys 2021 in critically ill patients. We also compared adverse drug events (ADEs) between the discordance and concordance groups for each antibiotic agent. Methods: A retrospective observational study was conducted on adult patients in medical intensive care units who were administered antibiotics as part of the antimicrobial stewardship program. Cystatin C and creatinine levels were measured on the same day. Differences in treatment outcomes and ADEs between the concordance and discordance groups were assessed using Pearson’s chi-squared and Mann–Whitney U tests. Results: A total of 171 patients with serum cystatin C were included. The mean ± standard deviation (SD) age and BMI were 67.23 ± 17.45 years and 22.71 ± 4.58 kg/m2. Meropenem was the most frequent antibiotic agent use (75.44%). Thirty-five patients (20.47%) were categorized into the concordance group, while one hundred and thirty-six patients (79.53%) were placed in the discordance group. There were no statistically significant differences between the concordance group and discordance group for treatment outcomes. In the discordance group, there was a significantly higher incidence of acute kidney injury (AKI) compared to the concordance group, with rates of 56.76% versus 22.22% (p = 0.009). Additionally, the discordance group also experienced a significantly higher rate of AKI with colistin, at 77.78% compared to 41.67% in the concordance group (p = 0.012). The highest discordance drug was piperacillin/tazobactam (55.26%), followed by aminoglycosides (50.00%) and vancomycin (49.02%). Conclusions: Our study showed that using a cystatin C-based equation may help prevent AKI without negatively impacting clinical outcomes. Future clinical research is required with large populations.
Essential Medicines List and Health Technology Assessment. Two complementary strategies to prioritize medicines in health systems
This article describes two strategies for incorporating medicines into national health coverage programs: the use of the WHO Essential Medicines List (EML) as a model for National Medicines Lists, and the implementation of Health Technology Assessment (HTA). We also put forward the main challenges that countries face, both in normal situations, as well as under financially restrictive conditions or during health or environmental emergencies Historically, high-income countries have used the HTA as a tool for incorporating medicines into their healthcare system, and low- and middle-income countries (LMIC) have followed the WHO EML. However, in recent years we have observed an increase in the use of HTAs in LMIC as well as the use of EMLs under special circumstances in high-income countries. Although both strategies partially share their basic methodological core, they differ in the procedure of selecting health problem, in using modeling procedure for economic assessment and in their final outcomes. The goal of this article is to evaluate the validity of the concept of essential medicines (EM) in times of increasing use of the HTA, and the need for relying on both strategies when making evidence-based healthcare decisions.
Possible Effect of Allopurinol and Risk of Dementia: An Updated Meta-Analysis
Background: Allopurinol is widely prescribed for the management of gout and hyperuricemia through inhibition of xanthine oxidase. While uric acid possesses antioxidant properties, xanthine oxidase activity contributes to oxidative stress, raising uncertainty regarding the long-term cognitive effects of allopurinol therapy. The association between chronic allopurinol use and dementia risk remains unclear. This updated meta-analysis aimed to evaluate the association between long-term allopurinol exposure and the risk of incident dementia in patients with gout or hyperuricemia. Methods: This systematic review and meta-analysis was conducted and reported in line with PRISMA reporting principles. PubMed, MEDLINE, and the Cochrane Library were systematically searched for observational studies published between January 2015 and August 2024. Study quality was assessed using the Newcastle–Ottawa Scale. Adjusted hazard ratios (HRs) derived from time-to-event analyses were prespecified as the primary effect measure, reflecting longitudinal dementia risk, while adjusted odds ratios (ORs) were analyzed separately as a secondary outcome. Meta-analyses were performed using a random-effects model in Review Manager (RevMan) version 5.4. Results: Nine studies met the inclusion criteria, comprising cohort, case-control, and nested case-control designs. In the primary HR-based meta-analysis, long-term allopurinol use was not associated with an increased risk of dementia, with substantial heterogeneity observed. Sensitivity analyses excluding one influential cohort study demonstrated a statistically significant reduction in incident dementia, with reduced heterogeneity. Across individual studies, most effect estimates were below unity, suggesting a neutral-to-potentially protective association. OR-based analyses were limited in number and showed no consistent association. Conclusion: Current evidence indicates that long-term allopurinol therapy is associated with a reduced incidence of dementia in populations, as suggested by sensitivity analyses. These findings support the cognitive safety of allopurinol in routine clinical practice and demonstrate the value of pharmacist-led medication review and longitudinal monitoring. Further well-designed prospective studies are warranted to clarify causality and identify subgroups most likely to benefit.
Internal validity gaps in repurposing olopatadine ophthalmic solution for intranasal use: A Regulatory and scientific feasibility appraisal for Thailand
Background: Allergic rhinitis is a prevalent condition that often requires local treatment to minimize systemic side effects. While intranasal antihistamines are effective, access in some settings is limited. Olopatadine hydrochloride, currently approved for ophthalmic use, has pharmacological properties that may be suitable for intranasal administration. Objective: To evaluate the feasibility of repurposing olopatadine hydrochloride ophthalmic solution for intranasal use in treating allergic rhinitis by assessing pharmacologic rationale, formulation characteristics, safety, and regulatory considerations. Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines. Eligible studies included randomized controlled trials (RCTs), pharmacokinetic investigations, mucosal safety assessments, and regulatory evaluations relevant to the intranasal administration of olopatadine. Risk of bias was appraised using the Cochrane RoB 2.0 tool for RCTs and the OHAT tool for non-randomized or preclinical studies. Findings were synthesized narratively, with meta-analysis performed where appropriate. Results: No studies were identified directly evaluated the intranasal use of olopatadine ophthalmic formulation. However, high-quality RCTs on olopatadine nasal spray (0.6%) demonstrated statistically significant improvements in allergic rhinitis symptoms, with an absolute risk reduction of 11.7%, a number needed to treat (NNT) of approximately 8.3, and low heterogeneity (I² = 19.5%). Despite these findings, they are not directly generalizable to the ophthalmic product due to formulation differences—including concentration, excipients, and pharmacokinetic properties—as well as the absence of population-bridging data for Thai patients. Additionally, no mucosal safety data or physiologically based pharmacokinetic (PBPK) models were identified to support intranasal safety or predict systemic exposure using ophthalmic preparation. Conclusions: Findings suggest pharmacologic and pharmaceutical feasibility for intranasal repurposing of olopatadine hydrochloride ophthalmic solution. While preclinical and clinical studies are needed to confirm efficacy and safety in nasal administration, the data provide a preliminary foundation for further development.
Abuse of Dextromethorphan, Naphazoline, and Carbamazepine in Community Pharmacies and Health Centers
Purpose: This study aims to collect data on the prevalence of abuse of dextromethorphan, naphazoline, and Carbamazepine from pharmacies and comprehensive health centers in Al-Karak, Jordan. Moreover, it seeks to understand the medical staff awareness and knowledge of this issue. Method: This cross-sectional study was conducted between July 2023 and October 2023 and two questionnaire forms were constructed. The first one was handed to pharmacists in twenty community pharmacies in Al-Karak. The second one was distributed to physicians who work in five comprehensive health centers in the same area. Results and conclusion: This study showed that cold and cough medications containing dextromethorphan and ophthalmic solutions containing naphazoline are the most widely abused OTC drugs (55% and 45%, respectively). Most pharmacists (95%) agreed that dextromethorphan can cause euphoria and hallucination at high doses, and 80% recognized that naphazoline can cause similar effects. All physicians (100%) stated that OTC drugs can be abused, and all participants reported that dextromethorphan and naphazoline can cause euphoria and hallucinations if overused. Most participants from both pharmacies and health centers had faced suspected cases of OTC drug abuse. Almost 95% of pharmacists suspected the abuse of dextromethorphan and naphazoline, and 60% noted that suspicious customers were both regular and strangers. Among health center participants, 80% prescribed these drugs daily, while 20% prescribed them 2 to 6 days per week. The main reasons for abuse were identified as these drugs were non-prescribed and easily accessible. Regarding carbamazepine abuse, which is a prescribed drug, 55% of pharmacists stated that carbamazepine has a potential for abuse, and the demand for it had increased recently. Moreover, 65% reported that people often requested multiple packs at once. Among physicians, 80% stated that carbamazepine has a potential for abuse and 40% observed that specific individuals requested carbamazepine more frequently than others did and displayed signs and symptoms of carbamazepine abuse
Pharmacy Students’ Knowledge, Attitude, and Practice Regarding Emergency Contraception in Lebanon: A Cross-Sectional Study
Background: Emergency contraception (EC) is a critical intervention for preventing unintended pregnancies when used promptly after unprotected intercourse. Despite its accessibility, misconceptions and inadequate knowledge about EC among pharmacy students may hinder its effective use. Objective: The aim of this study is to assess the knowledge, attitudes, and practices of pharmacy students regarding emergency contraceptives and explore factors influencing their knowledge, perceptions, and behaviors towards emergency contraception. Methods: This is a cross-sectional study that was conducted between December 2023 and February 2024 at the School of Pharmacy, Lebanese International University. A structured and validated questionnaire was distributed to 366 pharmacy students in their third, fourth, fifth, and PharmD years. The survey was divided into four parts: demographics, knowledge, attitude, and practice. Bivariable and multivariable analysis were conducted to identify demographic factors significantly associated with knowledge about EC and attitudes towards EC. Results: The majority of participants were female (79.8%) with a median age of 22 years. Knowledge about EC was inadequate. Fifth-year and PharmD students, as well as those working in community pharmacies, exhibited significantly higher knowledge scores. Attitudes towards non-prescription EC were predominantly negative. Religious affiliation strongly influenced attitudes, with students without religious ties showing more favorable perceptions. Among students working in pharmacies, only 58.3% reported readiness to dispense EC, citing moral and knowledge-related barriers. Conclusion: Pharmacy students in Lebanon showed inadequate knowledge and largely negative attitudes towards EC, underscoring the need for educational interventions in pharmacy curricula to address misconceptions about EC among pharmacy students and improve their readiness to counsel and dispense EC in their respective communities.
Effectiveness of a Pharmacist-Led Educational Intervention on Safe Disposal of Unused and Expired Medications in Klang Valley, Malaysia: A Pre-Post Interventional Study
Background: The consequences of unused and expired medications encompass environmental contamination, increased global warming risks, wastage of public resources, and unintentional poisoning resulting from accidental ingestion. Methods: An interventional research study was carried out for a duration of eleven months. The respondents participated in this study via invitation from email, WhatsApp messages, and other social media platforms. All respondents had answered a pre-intervention questionnaire prior to the educational intervention, followed by seven days of educational intervention, as well as a final data collection on the seventh day. Results: The study successfully obtained 397 responses in pre-intervention, and 353 responses in post-intervention, thereby achieving a response rate of 89%. The knowledge score of the respondents had enhanced to a sufficient level from 44.4% to 91.2% upon completion of the educational intervention. Vitamins (Npre=194, 48.9%; Npost=222, 62.9%), and cough preparation (Npre=193, 48.6%; Npost=219, 62.0%) were the two most widely existing unused and/or expired medications in pre-and post-intervention. An excessive number of medications (Npre=230, 57.9%; Npost=215, 60.9%), and improvement in the illness condition (Npre=158, 39.8%; Npost=261, 73.9%) were known as the two most common reasons for having unused and/or expired medications in pre-and post- intervention. Approximately 90% of the respondents (n=317) would participate in the “Return Your Medicines Program” in managing unused and/or expired medications after receiving the educational intervention. Conclusion: The educational intervention demonstrated a positive impact in enhancing the knowledge, attitude, and practice regarding the safe disposal of unused and expired medications.
Effectiveness of educational intervention on the knowledge, attitudes, and perceptions of community pharmacists regarding colorectal cancer screening in Klang Valley, Malaysia
Background: In Malaysia, a lack of awareness and negative perceptions of cancer screening have contributed to a delay in detecting colorectal cancer. Community pharmacists may play important roles in promoting colorectal cancer screening among the public. Previous research has shown that community pharmacists’ participation in cancer screening is hindered by inadequate knowledge, highlighting the need for educational interventions. Objectives: This study aimed to assess the knowledge, attitudes, and perceptions (KAP) of community pharmacists regarding colorectal cancer screening. Additionally, it sought to evaluate the impact of an online educational intervention designed to improve their KAP. Methods: Fully registered community pharmacists working within the Klang Valley were recruited using convenience and snowball sampling methods. A 3-day online educational intervention was conducted in small intervention groups using a social media application. Post-intervention KAP levels were compared to baseline. Results: The study recruited 303 respondents. The baseline assessment revealed a “satisfactory” level of knowledge (medianpre=72.22%), “good” attitudes (medianpre=80.00%), and “satisfactory” perceptions (medianpre=60.00%). Following the intervention, all three variables showed statistically significant improvements to “good” knowledge (94.44%), “good” attitudes (80.00%), and “good” perceptions (80.00%). Male pharmacists were associated with a higher level of perception towards colorectal cancer screening. Conclusion: The online educational intervention significantly improved community pharmacists’ KAP on colorectal cancer screening. The findings from this study underscore the potential of social media applications as a medium for educating community pharmacists to enhance their practice.
Pharmacological and Adjunctive Wound Healing Interventions in the Elderly: A Systematic Review and Meta-Analysis with Implications for Pharmacy Practice
Background: Chronic wound healing in elderly populations is complicated by age-related physiological decline, multimorbidity, polypharmacy, and underrepresentation in clinical trials. Pharmacists play an expanding role in multidisciplinary geriatric wound care, particularly in optimizing topical therapies, nutritional support, and deprescribing. Objective: To evaluate the effectiveness of wound healing interventions in elderly individuals (aged ≥60 years), focusing on pharmacist-relevant strategies, and appraise the internal validity and certainty of evidence using GRADE methodology. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 and the Cochrane Handbook. Studies included randomized controlled trials and prospective comparative studies assessing interventions such as biological dressings, nutritional supplements, and adjunctive technologies for chronic wounds in older adults. Primary outcomes included wound closure and healing time; secondary outcomes included pain, wound size reduction, and cost-effectiveness. Risk of bias was assessed using RoB 2 and ROBINS-I tools. Results: Of 276 records screened, 8 studies were included; 3 were eligible for meta analysis. Pharmacist-relevant interventions such as honey, silicone, and acellular dermal matrix (ADM) dressings significantly improved complete wound healing (pooled RR = 2.66; 95% CI: 1.88–3.76; high certainty). Nutritional supplementation accelerated healing (MD ranging from 6 to 22 days faster) and showed economic benefits ($881 saved/patient), though with low certainty. Pain and wound size reduction outcomes also favored intervention groups. Conclusion: Pharmacist-relevant interventions, particularly biological dressings and nutritional strategies, demonstrate clinically and economically meaningful benefits in elderly wound care. These findings support the integration of pharmacists into geriatric wound management protocols and highlight the need for geriatric-specific, high-quality trials.
The role of the community pharmacy in the fight against antimicrobial resistance: A Survey in Italy
Background: In the last decades, the inappropriate use of anti-microbials has accelerated the spread of AntiMicrobial Resistances (AMR). Italy has been among the countries in Europe with the highest percentages of resistance to the principal classes of antibiotics. Objective. in 2024 we developed a nationwide project in Italy titled “Antimicrobial resistance: it’s time to act”. The main objectives were: to increase the knowledge among community pharmacists of the phenomenon of AMR and Group A Streptococcus (GAS) infections; to investigate, among the population attending community pharmacies, the knowledge of the risks associated with the incorrect use of antibiotics (Phase 1), and the prevalence of GAS infections (Phase 2). Methods. The study was conducted in Italian in community pharmacies. Phase 1 was subdivided into two phases: in Phase 1A, the investigation was carried out by using a self- administered questionnaire, whereas in Phase1B, the same questionnaire was administered to users by the community pharmacist. In Phase 2, data were gathered recording the results of rapid tests to detect GAS infections. Results. During Phase 1, data was collected in 778 pharmacies. 14.507 subjects were interviewed. During phase 2, 218 pharmacies participated and 1.914 subjects were enrolled. The Phase 1 investigation showed that there was a significant lack of awareness of AMR among the study population. The data collected enable us to highlight the need for health care professionals to provide the education of the Italian population on the issue of AMR. Regarding Phase 2, it is possible to affirm that the presence of general symptoms consistent with a GAS infection was not at all predictive of a positive result to the rapid test with the exception of the 0-10-year-old age group. Considering, however, more specifically those who declared a set of symptoms affecting the throat, the likelihood that a subject has a positive test rises significantly with age. Conclusions. In light of these results, and the fact that community pharmacies are among the health services most easily accessible to the general public, their active involvement in any campaign to raise awareness and educate the population on the topic of AMR should be considered.
Factors associated with adverse drug reactions among residents in nursing home
Background and aim: Adverse drug reactions (ADRs) are a significant public health concern, especially in the elderly. Factors like multimorbidity, polypharmacy, frailty, and age-related changes in drug metabolism increase variability in drug response and adverse effects. The objectives of this research is to examine the prevalence of ADRs in elderly residents of nursing homes and to identify the most significant risk factors contributing to these events. Material and methods: This was a retrospective, cross-sectional study that reviewed the medical records of 125 residents in two nursing homes. The study population consisted of all residents aged 65 years or older. Resident characteristics included age, gender, clinical diagnoses, number of comorbidities, residents` functional status, and complete medication history were analyzed using general practitioner documentation in residents` records. Relevant clinical information on ADR characteristics was documented through chart over 12 months. Results: The study included 125 residents with a mean age of 76.52 (SD 7.83), the majority of them were women (66%), with polypharmacy of 5 and above (48%). Overall 10% of elderlies took >10 medications (prescribed or over the counter), and 38% took 5-9. In addition, the mean number of chronic comorbid conditions was approximately four. Mean Charlson comorbidity index was 1.7. Residents with higher Charlson Comorbidity Index showed increased risk of ADRs, r=.552, p<.001. We found patients with non-ADRs used less medications (M=3.88, SD=1.56) compared to those with ADSRs (M=7.26, SD=1.27, t(123)=-6.51, p<.001). Cardiovascular, gastrointestinal, and anticoagulant medications were associated to ADRs. Finally using Pearson`s r correlation coefficient we found that there is a significant positive relationship between ADRs and specific drug classes use as well as higher polypharmacy and comorbidity. Conclusion: This study highlights the high prevalence of ADRs among elderly patients, with a positive association to polypharmacy, comorbidities, and specific drug classes use.
Future perspectives on household pharmaceutical management and medication administration for companion animals in Japan
Background: Companion animals are increasingly viewed as family members, with growing attention to their health and well-being. However, improper storage and use of medications at home can pose risks such as accidental ingestion by companion animals or children, health deterioration due to drug exposure, and environmental harm. In Japan, while the demand for advanced veterinary care is rising, there is limited information on how medications for companion animals are managed and administered at home. Objective: This study aimed to investigate, for the first time, the real-world practices and challenges related to the storage, handling, and administration of medications for companion animals in Japanese households. Methods: A questionnaire survey was conducted between April and July 2024 via Google Forms. The survey addressed two key aspects: medication storage and management, and administration difficulties experienced by owners. Ethical approval was obtained from the Tohoku Medical and Pharmaceutical University Ethics Committee. Results: A questionnaire was distributed to 2862 companion animal owners, and 191 responses were received (response rate: 6.7%). Most respondents were women in their 50s or 60s living in the Kanto region, and dogs were the most common companion animals. Medication storage practices were generally appropriate, although some instances of storage in high-humidity or unstable-temperature areas were observed. There were 10 cases reported in which companion animals either accidentally ingested or attempted to ingest human medications. While many owners reported no difficulties with medication administration, others highlighted challenges such as companion animals spitting out the medication, bitterness of medications, and difficulties adjusting administration times to personal schedules. Approximately 20% of the owners modified medications prior to administration, including crushing tablets or measuring liquids. Conclusion: This study provides initial insights into medication management for companion animals in Japanese households. Although storage was largely appropriate, issues related to administration and accidental ingestion were identified. This study highlights the potential role of pharmacists in supporting appropriate veterinary medication use through formulation adjustments and pharmaceutical care, ultimately improving adherence and reducing stress for both owners and companion animals.
Development of a new spectrophotometric method for the determination of flavonoids in herb of red clover (Trifolium pratense L) and zigzag clover (Trifolium medium L)
Objective: Medicinal plants containing flavonoids are attracting increasing interest of researchers due to their complex therapeutic effects on the human body. Such medicinal plants include representatives of the genus Clover - red clover (Trifolium pratense L.) and zigzag clover (Trifolium medium L.). Methods: However, spectrophotometric techniques for the determination of the total flavonoids have numerous disadvantages, which prompted the development of a new analytical technique. As a result of our research, such a technique using gallium (III) nitrate as a staining reagent instead of the traditionally used aluminium chloride was developed, and a standard for recalculation (luteolin) was substantiated. Results: It has been shown that the new methodology is capable of giving satisfactory results, is characterised by excellent metrological characteristics, meets the requirements of SP RF XV ed. and the leading pharmacopoeias of the world (EP, USP, JP). Conclusion: The proposed methodology can be recommended for use not only for scientific purposes, but also in the field of standardisation of plant raw materials at pharmaceutical industries specialising in the production of medicinal preparations of plant origin.
Women’s awareness and experience of analgesic use during pregnancy in the UAE
Background: Pregnancy is a critical phase in a woman’s life, marked by significant physiological and emotional changes. Cautious and safe pain management during this period requires a careful evaluation of the benefits and risks of analgesic drug use. Paracetamol is the preferred choice, considered generally the safest option, while NSAIDs, especially in early pregnancy, carry potential risks like an increased risk of miscarriage and congenital disabilities. This study aimed to assess the knowledge, self-medication behaviors, and sources of information regarding analgesic use during pregnancy among women in the UAE. Methods: This cross-sectional study was conducted using a self-administered online questionnaire. The survey was validated through expert review and pilot-tested for clarity and reliability. The questionnaire was distributed via social media platforms. Data collection took place from October 2022 to May 2023. A convenience sampling method was employed, targeting women residing in the UAE with at least one pregnancy experience. The collected data were analyzed using SPSS V.26, employing descriptive and inferential statistics to assess knowledge levels and identify significant associations. Results: Among 405 participants, 64.4% reported using analgesics during pregnancy, with 38.3% specifically using them in the first trimester. Paracetamol was the most commonly used analgesic 33.3%, and 39% of participants self-medicated without consulting a healthcare provider. While 70.6% correctly identified paracetamol as the safest analgesic, 58.3% acknowledged potential fetal risks from long-term analgesic use. Higher awareness was significantly associated with younger age (p = 0.035), higher education (p = 0.003), and a medical background (p < 0.001). Participants who used analgesics in the first trimester had significantly higher awareness levels (p = 0.004, 71.6%), particularly those who took paracetamol (p = 0.002, 76.7%). Self-medication was also linked to greater awareness (p = 0.006). Additionally, awareness levels were significantly higher among participants who obtained information from pharmacists (p = 0.004, 94.4%) and books (p = 0.004, 90.0%). Conclusions: The study concludes by highlighting the need for better education and awareness among UAE women regarding the use of analgesics during pregnancy. The results show that many women self-administer analgesics without seeking medical help, which could be associated with potential risks. Policymakers and healthcare professionals must create focused educational initiatives to arm pregnant mothers with accurate knowledge about safe analgesic dosages and options during pregnancy.
Incidence and pattern of anticoagulation in patients with atrialfibrillation and atrial flutter at tertiary hospital in Oman
Background: Atrial fibrillation (AF) and atrial flutter (AFL) are the two most common cardiac arrhythmias encountered in clinical practice. Anticoagulants are the cornerstone in cerebrovascular accident prevention in these patients. Despite their role in reducing stroke risk, emergency room visits, and overall treatment costs, studies have shown that oral anticoagulants (OAC) are underutilized, even in high-risk patients. Objective: The aim of this study is to explore the appropriateness and pattern of anticoagulant prescriptions in patients with AF and/or AFL in a tertiary hospital as recommended by the international guidelines. Method: This retrospective observational study was conducted by reviewing the electronic medical records of 389 adult patients with either AF or AFL in Sultan Qaboos University Hospital (SQUH) between July 2018 and July 2020. The appropriateness of oral anticoagulation was assessed according to international guidelines, namely, 2020 Canadian Cardiology Society (CCS), 2020 European Society of Cardiology (ESC), and 2019 American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS). Analysis was performed using univariate statistics (Chi-square and percentages) to report categorical data. Results: Oral anticoagulants were prescribed appropriately in 91% of the patients according to CCS guidelines, and 92% and 96% according to ESC and (AHA/ACC/HRS) class Ia and IIa recommendations, respectively. Among non-anticoagulated patients (28 patients, 9%) had proper justification. On the other hand, 38 patients (9.8%) out of the whole cohort (389) had a CHADS-65 score of zero but received OAC mostly due to cardioversion, rheumatic heart disease, or mechanical heart valve prosthesis. Novel oral anticoagulants (NOACs) were the most commonly used OAC 251/336 (75%), with rivaroxaban being the main drug used 234/250 (92%) of all NOAC prescriptions. 75% of patients with eGFR<50 ml/min received the proper dose of rivaroxaban. Bleeding was the most frequently reported side effect of OAC in 52 (13.4%) of the entire cohort. Conclusion: Nearly 91% of patients with AF/AFL followed at SQUH were prescribed an appropriate anticoagulant as per international guidelines. The decisions to anticoagulate a patient with AF/AFL and the type of anticoagulant used were appropriate.
Copyright (c) 2025 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/
Impact of Sublingual Glutathione on Oxidative Biomarkers and Behavior in Children with Autism: A Pilot Investigation with Pharmacist Involvement
Background: Autism Spectrum Disorder (ASD) is defined by impairments in social communication, repetitive behaviors, and cognitive variability. Oxidative stress is associated with the pathogenesis of ASD, characterized by imbalances between oxidants and antioxidants, particularly reduced glutathione (GSH). Although glutathione supplementation shows potential, its clinical efficacy remains inconsistent due to limited bioavailability when administered orally. Objectives: This study aimed to assess the impact of sublingual glutathione supplementation on oxidative stress indicators and behavioral outcomes in children diagnosed with ASD. Methods: A total of 25 children with ASD, aged 7 to 18 years, and 25 matched healthy controls participated in an openlabel, pre-post intervention trial. The ASD group administered sublingual reduced glutathione for a duration of six weeks. A clinical pharmacist, member of research team, supervised supplement dispensing, provided caregiver counseling, and monitored adherence throughout the study. Serum oxidative stress markers, comprising reduced glutathione (GSH), oxidized glutathione (GSSG), GSH/GSSG ratio, total antioxidant capacity (TAC), total oxidant status (TOS), malondialdehyde (MDA), and protein carbonyl levels, were assessed at baseline, three weeks, and six weeks. evaluations utilized the Assessment of Basic Language and Learning Skills-Revised (ABLLS-R). Results: Baseline oxidative stress markers showed elevated stress levels and diminished antioxidant capacity in patients with ASD compared to controls (p < 0.05). Following the intervention, notable improvements in antioxidant status, as measured by GSH, the GSH/GSSG ratio, and TAC, were observed. Behavioral improvements were significant in specific domains, including cooperation, imitation, social interaction, visual performance, vocal imitation, play, and receptive language. Conclusions: Sublingual glutathione supplementation significantly elevated antioxidant levels and specifically improved behavioral functioning in children with ASD. Pharmacist involvement contributed to proper administration and adherence, supporting the effective delivery of the intervention. These data indicate the possible usefulness of antioxidant therapy in the management of oxidative stress-related symptoms in ASD. Additional randomized controlled trials are advised.
Kosovo’s Pharmaceutical Regulation: A Comparative Study withCroatia on Medicine Availability, Regulatory Frameworks, and EUCompliance
Introduction: Kosovo and Croatia share a common regulatory and historical background, yet their pharmaceutical systems have developed along different trajectories. Croatia’s EU membership and strategic investments have enabled full regulatory integration, while Kosovo continues to face structural and institutional challenges despite aligning its legal framework with EU standards. Key differences are evident in marketing authorization procedures, medicine availability, and regulatory implementation. Thus, this study highlights these gaps that Kosovo must strengthen and adopt EU-aligned best practices. Objectives: This study aims to analyze Kosovo’s current pharmaceutical regulatory system, particularly its alignment with EU standards, using Croatia’s well-established system as a benchmark. In addition, the aim of this paper is to evaluate the marketing authorization procedures in Kosovo compared to Croatia and also assess the availability and diversity of marketing-authorized medicines in both countries. Furthermore, a key focus area is the availability of New Molecular Entities in both countries and identifying the gaps in Kosovo’s pharmaceutical market. Materials and Methods: A comparative and analytical approach to the pharmaceutical regulatory framework of Kosovo and Croatia is used in this study. Data were collected from national and EU legislation, and the official regulatory agency databases from September 2024 to January 2025. Data were analyzed using thematic content analysis to identify regulatory themes and a quantitative comparison to assess the number and diversity of marketing-authorized medicines in both countries. The study further examines the differences in NME registration, using databases from the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA). Results: Our study finds that while Kosovo is taking steps to align its pharmaceutical regulations with EU standards, significant gaps remain, particularly in clinical trials, public engagement and digital infrastructure. On the other hand, Croatia exemplifies full EU compliance, with a transparent, efficient, and operational regulatory system that provides better market access, regulatory enforcement, and public interaction. Additionally, the number of marketing-authorized medicines is 26% higher in Croatia compared to Kosovo. One of the most notable findings of this study is the huge contrast between the availability of NMEs in Kosovo and Croatia. The results show that Kosovo has registered only six EMA-approved NMEs and four FDAapproved NMEs between 2021 and 2024. While Croatia counted 33 out of 46 EMA-approved NMEs in 2024 alone. Conclusion: This study presents the first comparative analysis of the pharmaceutical regulatory systems of Croatia and Kosovo, using Croatia as a model for EU-aligned practices. While Croatia has achieved streamlined medicine approvals and broader access through EU integration, Kosovo continues to face implementation challenges. Strengthening digital infrastructure, regulatory enforcement, and EU collaboration are crucial for Kosovo to close the access gap and modernize its system. Croatia’s experience offers valuable guidance for Kosovo’s regulatory development.
Utilization and Predictors of PPI Co-Prescription in Warfarin-Treated Patients: Opportunities for Clinical Pharmacy Intervention
Background: Warfarin is recommended for several diseases, but it may cause bleeding particularly gastrointestinal bleeding. Proton pump inhibitor (PPI) is recommended in five conditions such as history of peptic ulcer disease, co-administration of antiplatelet, NSAIDs, or corticosteroids. There is limited data on PPI prophylaxis in patients with warfarin treatment with these five conditions. Objective: This study aimed to find additional predictors for PPI prophylaxis in patients who received warfarin therapy with any other recommended factors. Methods: This study was a retrospective cohort study conducted on hospital database of Khon Kaen University, Thailand. The inclusion criteria were adult patients who received warfarin therapy with any indications and were indicated for PPI prophylaxis by presence of one of any recommended factors mentioned above. Rates of PPI prophylaxis in the five conditions and clinical factor predictive PPI prescription were analyzed. Results: There were 1,789 patients who required PPI prevention while taking warfarin. The mean age of all patients was 70.45 year with a proportion of male patient of 51.87%. Of those, 611 patients (34.15%) received PPI prevention. According to the recommended factors, the PPI group had higher proportions of patients with age of more than 65 years (80.36% vs 73.60%), uncomplicated peptic ulcer disease (2.95% vs 0.68%), and concomitant corticosteroid (27.66% vs 12.31%) than the non-PPI group significantly. Concomitant antiplatelet and NSAIDs were not significant (p value = 0.665 and 0.458). Several predictors for PPI prophylaxis were identified such as diabetes, ischemic heart disease, treatment with clopidogrel, or internists as a primary physician. Conclusions: PPI prophylaxis in patients treated with warfarin was low at 34.15%. Predictors both positively and negatively of PPI prophylaxis were identified in five categories. Physicians who treat patients with warfarin therapy should be acknowledged on PPI prophylaxis appropriately. Additionally, these findings highlight the need for pharmacy-led interventions, such as clinical audits or risk assessment tools, to ensure appropriate gastroprotection in patients on warfarin.
Cost-effectiveness analysis of a unit dose dispensing robot in Thailand
Background: Medication errors can lead to serious consequences, including adverse drug events and even death. To reduce medication errors, many hospitals have implemented medication-dispensing technologies, including the Unit Dose Dispensing Robot (UDRs). However, no studies in Thailand have evaluated the costs and medication errors associated with UDRs. Objective: To conduct a cost-effectiveness analysis of the adoption of UDRs in comparison to traditional manual dispensing methods, focusing on costs and the reduction of medication errors. Method: Cost and medication error data were obtained from the database of a tertiary hospital in Thailand between 2017 and 2022. Medication errors were measured as the difference in error occurrence before and after UDR implementation. Cost components included labor costs, material costs, and the capital cost of UDRs. The incremental cost-effectiveness ratio (ICER) was calculated as the incremental cost per avoided medication error. One-way sensitivity analysis was performed to assess the impact of uncertainty in individual parameters on the results. Results: UDR implementation reduced wrong-drug, wrong-dose, and medication mix-up errors by 201, 62, and 6.33 events, respectively. Overall, UDRs prevented 269.34 medication errors annually at an incremental cost of 64,883.10 United States Dollars (USD), resulting in an ICER of 240.90 USD per avoided medication error. One-way sensitivity analysis indicated that the cost of medications after implementing the UDRs had the greatest influence on ICER variability, while labor costs after UDR implementation had the least impact. Conclusions: Implementing UDRs resulted in higher initial costs due to investments in infrastructure, technology, and labor; however, it significantly reduced medication errors. This evidence can be utilized to inform decision-makers in investing in automatic drug dispensers, promoting patient safety and increasing the efficiency of hospital medication dispensing systems in Thailand.
The effectiveness of Pharmacist-driven Medication optimization: A Retrospective study on Warfarin and Digoxin
Background: Warfarin and digoxin are essential for managing cardiovascular conditions but carry risks of adverse drug reactions (ADRs) due to their narrow therapeutic indices, particularly in patients on concurrent therapy, with polypharmacy, or chronic kidney disease (CKD). The role of clinical pharmacists in optimizing these therapies remains underexplored. Objective: To evaluate the impact of pharmacist-driven interventions on therapeutic success, ADRs, medication adherence, and hospital readmissions in patients on warfarin, digoxin, or both. Methods: This retrospective cohort study analyzed 270 patients at Farah Medical Complex, Amman, Jordan, from January to December 2023. Outcomes included therapeutic success, time to therapeutic target and stabilization, ADR incidence, adherence, and hospital readmissions. Data were analyzed using Kaplan-Meier survival analysis, Cox proportional hazards models, and multivariate logistic regression. Results: Of 270 patients (162 warfarin-only, 80 digoxin-only, 28 concurrent), pharmacists delivered 277 interventions (1.03/patient), achieving therapeutic success in 83.7% (226/270). Warfarin-only patients reached therapeutic INR in 88.2% within 8.2 ± 11 days, digoxin-only in 86.3% within 11 ± 13 days, and concurrent therapy in 85.7% (INR) and 71.4% (digoxin) within 9.1 ± 9 and 14 ± 11 days, stabilizing at 26–33 days. Frequent interventions (HR=1.61–1.92, p<0.001–0.014) reduced stabilization time by 7–12 days. Interventions tripled success odds (OR=2.87, p<0.001), prevented 18 ADRs (reducing the rate from 20.4% to 13.7%), and improved adherence odds (OR=1.73, p=0.07), increasing PDC by 6–12%. Polypharmacy (OR=1.89, p=0.02), CKD (OR=3.21, p=0.003), and concurrent therapy (OR=2.13, p=0.04) increased ADR risk, while polypharmacy reduced adherence (OR=0.58, p=0.02). Readmissions (38 events, 14.1% event rate) were reduced from 17.0% by preventing 8 events, though the concurrent subgroup had a 35.7% rate. Conclusions: Pharmacist-driven interventions significantly enhance therapeutic success, reduce ADRs, improve adherence, and lower readmissions in warfarin and digoxin therapy, particularly in high-risk patients, supporting their integration into cardiovascular care teams.
The impact of evidence-based interventions on depression in survivors of intimate partner violence: A Systematic review and meta-analysis
Background: Intimate partner violence (IPV) is a pervasive global issue that substantially increases the risk of depression, post-traumatic stress disorder (PTSD), and substance use disorders among survivors. Despite the known mental health consequences, there is limited synthesis of evidence regarding the effectiveness of therapeutic interventions targeting depression in this population. Objectives: To evaluate the effectiveness of pharmacological and psychosocial interventions in reducing depressive symptoms among survivors of IPV through a systematic review and meta-analysis. Methods: A comprehensive literature search was conducted in PubMed, PsycINFO, Scopus, Web of Science, and CINAHL for studies published between 2008 and 2025. Eligible studies included randomized controlled trials and quasi-experimental designs evaluating depression outcomes in IPV survivors aged ≥16 years. Data extraction and quality assessment were performed independently by two reviewers using standardized tools (RoB 2, ROBINS-I, and Newcastle-Ottawa Scale). Meta-analyses were conducted using random-effects models, with subgroup and meta-regression analyses to explore heterogeneity. Results: Eight studies met inclusion criteria, comprising six psychosocial and two combined psychosocial-pharmacological interventions. The pooled mean difference (MD) was -1.22 (95% CI: -1.27 to -1.18; p < 0.001), indicating a significant reduction in depressive symptoms. Digital interventions yielded a MD of -1.29 (95% CI: -1.87 to -0.70), while participatory models showed a MD of -0.79 (95% CI: -1.42 to -0.16). High heterogeneity was observed (I² = 99.58%). Metaregression revealed digital interventions were significantly associated with reduced depressive symptoms (coefficient = -1.41, p = 0.014). Conclusions: Evidence-based interventions, particularly digital and participatory models, can effectively reduce depression among IPV survivors. However, standalone interventions often yield limited outcomes. Integration with pharmacological treatments and long-term trauma-informed care is critical to enhance mental health recovery. Future research should focus on tailoring interventions to diverse populations and ensuring methodological rigor in evaluating long-term efficacy.