Search Results (150)

Background and Objectives: Antimicrobial stewardship plays a key role in the surgical setting by reducing the incidence of healthcare-associated infections and limiting the emergence of antimicrobial resistance. Clinical Decision Support Systems (CDSSs), when integrated into routine practice, are valuable tools for optimizing antimicrobial prescribing. However, evidence regarding their impact on surgical patients, particularly across different specialties, remains limited. Materials and Methods: We conducted a quasi-experimental time series study in surgical patients at a primary-level hospital, evaluating the effect of a CDSS on postoperative antimicrobial therapy. The pre-intervention period included patients admitted from April 2017 to September 2020, and the post-intervention period included those admitted from October 2020 to March 2024. Antimicrobial consumption and expenditures were measured as defined daily doses (DDDs) per 1000 patient-days and euros (€) per 1000 patient-days, respectively. Subgroup analyses were performed by the surgical service. Clinical outcomes included mortality and length of stay (LOS). Results: Following CDSS implementation, overall antimicrobial consumption decreased by 4.4%. Significant reductions were observed in aminoglycosides (−52.0%), macrolides, lincosamides and streptogramins (−40.6%), and fluoroquinolones (−32.3%). Reductions were heterogeneous across surgical services, with significant reductions in Traumatology (−21.3%) and Urology (−14.3%). Expenditures decreased from 3185.4 to 2733.9€/1000 patient-days (−14.2%; p = 0.17). Mortality remained stable, whereas significant reductions in LOS were observed in Urology (5 to 4 days, p = 0.03) and traumatology (16 to 8.5 days, p < 0.01). During the post-intervention period, 476 stewardship recommendations were issued for 330 patients, with an acceptance rate of 76.1%. The most frequent interventions were discontinuation of antimicrobials (25.8%), transition to oral therapy (21.0%), and de-escalation (18.7%). Conclusions: Implementation of a CDSS in the surgical setting was associated with reduced antimicrobial consumption, a downward trend in expenditures, and high acceptance of stewardship recommendations. Mortality remained unchanged, while reductions in LOS in selected services support the safety and potential efficiency of this approach. Full article

Background: Clinical pharmacy services (CPS) have been shown to confer significant advantages in patient care. It remains to be clarified how CPS resources are allocated across routine care settings. It remains to be clarified which recommendations are made to resolve the drug-related problems (DRP) identified by CPS and which adverse drug reactions (ADR) actually arise from the identified DRP. Methods: Following positive ethical approval, patient chart analyses, evaluation of pharmacy documentation on CPS and pharmacist interviews were performed to characterize CPS at all medical departments of the Bundeswehr Hospital Hamburg. We developed and pre-tested instruments for standardization: A Standard Operating Procedure (SOP) for the practical exercise and documentation of CPS by the pharmacists performing them, a standardized form (checklist) for retrospective data collection as part of this study, and a standardized questionnaire for conducting the pharmacist interviews including a risk assessment according to the NCC-MERP score. Results: In total, 1000 CPS were documented in 504 patients (mean age: 69.95 years; 229 female) on 16,705 treatment days. A total of 66.87% CPS was initiated when pharmacists participated in ward rounds. In all CPS, “Indications” was the topic addressed most frequently (37.70%). “Agents for obstructive respiratory diseases” was the most frequently involved drug class (11.32%). The most frequent processing time per CPS was 16–30 min (48.61%). The number of CPS ranged from 0.36/100 treatment days in dermatology to 12.47 in oncology. Severity of 358 DRP was classified “very severe” (5.03%), “severe” (42.74%), “moderate” (34.36%), “low” (15.08%), “very low” (1.40%), or “without impact” (1.40%). The probability of DRP occurrence was classified as “high” in 13.13% and “very high” in 3.35%. In 15.36% of the DRP, an ADR actually occurred. In 504 patients, 932 specific recommendations were forwarded to solve the DRP identified during CPS. Of those, 53.97% were implemented. Conclusions: In almost all CPS, a considerable number of DRP with serious clinical consequences were identified. Half of the forwarded recommendations were implemented. Full article

Background/Objectives: According to recent literature, the prevalence and incidence of long-term illnesses such as asthma and diabetes in young people have substantially risen over the past 13 years. Recent figures indicate that, in England, 4.10% of all prescriptions were prescribed for young people. The aim of this study was to investigate young people’s perspectives of pharmaceutical services provided by primary care pharmacists relating to medication. Methods: A cross-sectional survey using both online and paper-based tools was conducted from March to November 2019. The population for this survey was young people from 18 to 24 years old registered as students at one of the universities in England. The survey consisted of twenty-four questions, and they were a mix of closed-ended questions, such as multiple-choice and Likert scales, and open-ended questions. Results: A total of 210 out of 800 survey responses were completed from different recruitment sources, achieving a response rate of 26.25%. Most participants were female (62.38%), and the most frequent age was 18 years (35.24%). Among participants, 15.70% were diagnosed with long-term illnesses, of which 33.33% were reported as the respiratory disease, asthma. Pharmacists were not utilised as a source of information for young people, with the majority (60.60%) obtaining information from their doctors. Most of the participants (96.97%) had not taken part in a Medicines Use Review (MUR) or New Medicine Service (NMS), and 78.79% were not aware of any services or support groups by their pharmacist. Among different healthcare professionals, GPs and hospital doctors were the most frequently reported to discuss with young people about their illnesses. Conclusions: There is an opportunity to further develop pharmaceutical services and support by primary care pharmacists for young people with long-term illnesses. Policymakers and primary care pharmacists in the future could utilise the perceptions and opinions of young people found in the current study to inform the development of primary care pharmacy services to meet young people’s needs and perceptions. These results are of benefit to policymakers in assisting in the development of pharmacy services. Further research will enhance understanding of the perceptions of young people about the pharmaceutical services offered by primary care pharmacists with respect to medications. Full article

Background: Clonazepam is a benzodiazepine drug indicated in all clinical forms of epileptic seizures, various forms of myoclonic seizures, myoclonus and other abnormal movements. At present, it is classified as a hazardous drug requiring special precautions for personnel at reproductive risk, according to a technical document produced by the Spanish National Institute for Safety and Health at Work (INSST), in collaboration with the Spanish Society of Hospital Pharmacy (SEFH). The commercial solutions of clonazepam, for oral and parenteral administration, are supplied by laboratories in glass containers. Repacking in pre-filled polypropylene (PP) syringes, made in the pharmacy service, and in aseptic conditions, may facilitate its administration and reduce the risks to the health or safety of nursing personnel. Nevertheless, there is a lack of stability studies of clonazepam in pre-filled PP syringes. Objectives: To evaluate the physicochemical stability of commercial clonazepam 2.5 mg/mL oral solution and 1 mg/mL parenteral solution repackaged in pre-filled PP syringes under various storage conditions. Methods: A rapid, linear, precise and sensitive high-performance liquid chromatography (HPLC) method for chemical stability studies of Clonazepam 1 mg/mL (parenteral use) and 2.5 mg/mL (oral use) in solution was implemented after repackaging in pre-filled PP syringes. The studies were conducted by measuring concentrations of oral and parenteral clonazepam in pre-filled syringes, at various time points, over 30 days in several different storage conditions: oral clonazepam protected from light in refrigerator and at controlled room temperature exposed to ambient light; parenteral clonazepam protected from light in a refrigerator and at controlled room temperature protected or unprotected from light. Visual aspects and pH change as well as crystal formation were checked to determine physical stability. Results: The degradation of the active ingredient in all groups was less than 10% after 30 days. No evidence of crystal formation, pH and visual aspect changes were observed. Conclusions: Clonazepam 1 mg/mL parenteral solution and 2.5 mg/mL oral solution in pre-filled PP syringes are stable for up to 30 days in the tested conditions. The centralized repackaging of clonazepam in pre-filled PP syringes, connected to a closed safety system, in the pharmacy service, reduces drug manipulation by nursing staff decreasing the risk of occupational exposure. Full article

Background: Clinical pharmacy services (CPSs) play a key role in ensuring medication safety, optimizing pharmacotherapy, and improving patient outcomes. While their benefits are well-documented globally, their specific impact within the Saudi healthcare system remains underexplored. Objective: This study aimed to evaluate the impact of pharmacist-led interventions in a tertiary medical center in Saudi Arabia. Methods: A retrospective chart review was conducted at a 1200-bed academic hospital in western Saudi Arabia. Pharmacist interventions documented between 1 January 2023 and 31 December 2023 were analyzed. Interventions were categorized into 13 types, including dosage errors, unavailable medications, and drug–drug interactions. Descriptive statistics were used to summarize the data. Results: A total of 38,143 pharmacist interventions were recorded. Dosage errors accounted for 77.2% (n = 29,584) of interventions, followed by issues with medication availability (6.57%, n = 2519) and incorrect medication orders (4.59%, n = 1761). The most frequently implicated medications were acetylsalicylic acid, enoxaparin, and paracetamol, collectively representing 43.55% of interventions. The highest intervention rates were in the Emergency Department (25.3%, n = 11,050), Oncology Clinics (9.81%, n = 4285), and Male Medical Units (9.43%, n = 4119). Conclusions: Clinical pharmacists play a significant role in reducing medication errors and improving patient safety across various specialties. Their targeted interventions optimize therapeutic outcomes, highlighting the need for integrating advanced tools and expanding CPSs to meet evolving healthcare demands in Saudi Arabia. Full article

Pharmacy technicians (PT) are vital to the efficient and safe operation of hospital pharmacy services, fulfilling a range of technical and clinical responsibilities that directly impact patient care. However, increasing healthcare demands have underscored the importance of adequate staffing levels to sustain service quality and safeguard patient outcomes. This perspective paper explores how appropriate staffing levels for PT in hospital settings are essential and important to support safe, efficient care and a sustainable workforce. It compares evidence-informed staffing models, highlights real-world benchmarks, and proposes governance recommendations to guide policies that strengthen pharmacy services. Recommendations are made to inform clinical governance, suggesting that staffing policies, continuous training, and professional development programs are essential to supporting PT effectiveness and retention. The findings advocate for regulated staffing ratios and governance measures to foster an environment where PTs can deliver high-quality care and uphold safety standards within hospital pharmacies. Full article

Background/Objectives: Access to health services is often limited due to socio-economic and organizational determinants of health systems, which lead to increased unmet healthcare needs. This study aimed to identify access barriers for the general population in Greece, including those that may have emerged following the COVID-19 pandemic. Methods: This was a cross-sectional survey of 1002 Greek citizens. A questionnaire regarding socio-demographics, healthcare utilization, and access to health services was used. Interviews took place between October and November 2022. Results: Of 837 participants who used health services in 2022, 82.6% had a medical consultation, 80.6% took diagnostic tests, and 63.6% visited a pharmacy for pharmaceuticals. Of those having a medical consultation, 33.1% did so at an NHS health unit, while 75% of the participants taking diagnostic tests visited a contracted private laboratory. Out of the 135 participants requiring hospitalization, 62% were hospitalized in a public hospital, while 85% of the participants requiring pharmaceuticals visited a private pharmacy. Access barriers in the past year were reported by 48% of the participants requiring a medical consultation, 34% of the participants requiring diagnostic tests, and 40% of the participants requiring hospitalization. The most common barriers were long waiting times and financial constraints. The main barrier to accessing pharmaceuticals was the availability and administration of the product. Conclusions: The identified healthcare access barriers highlight the vulnerabilities of the current health system in Greece, which were further exposed during the COVID-19 pandemic crisis. Addressing socioeconomic factors that are considered key access indicators should be the focus of future health policy initiatives. Full article

This study investigates the accessibility of public healthcare services in Olsztyn County, a major urban center in the Warmia and Mazury region of Poland. The aim was to develop a methodological framework using Geographic Information System (GIS) tools and spatial data to assess the local availability of healthcare infrastructure. The analysis included key facilities such as hospitals, clinics, pharmacies, and specialized outpatient services. A spatial accessibility indicator was constructed to evaluate and compare access levels across municipalities. The results show a clear disparity between urban and rural areas, with significantly better access in cities. Several rural municipalities were found to have limited or no access to essential healthcare services. These findings highlight the uneven spatial distribution of medical infrastructure and point to the need for targeted strategies to improve service availability in underserved areas. The proposed methodological approach may support future studies and inform local and regional planning aimed at reducing healthcare inequalities and improving access for all residents, regardless of their location. This research contributes to the growing body of evidence emphasizing the role of spatial analysis in assessing public service accessibility and supports the development of more equitable healthcare systems at the local level. Full article

Therapeutic drug monitoring (TDM) is routinely recommended for most antifungal triazoles to ensure efficacy and safety. Isavuconazole, however, was initially approved without this recommendation due to its predictable pharmacokinetic profile. Later clinical data have raised concerns about subtherapeutic exposures in certain populations. This prospective, single-center study aimed to assess the need for TDM of isavuconazole in critically ill and hematologic patients with invasive fungal infections. Between March 2022 and November 2023, patients receiving standard dosing of isavuconazole were enrolled, and plasma concentrations were measured to determine the proportion of patients with values outside the therapeutic range (1–4 µg/mL), particularly focusing on subtherapeutic levels. A total of 65 isavuconazole plasma concentrations from 24 patients (9 critically ill and 15 hematologic) were analyzed. Critically ill patients had lower initial concentrations than hematologic patients (median [range]: 0.75 [not detectable (ND)–5.18] vs. 3.03 [1.03–6.65] µg/mL), with 66.7% showing levels outside the therapeutic range and 55.5% having subtherapeutic concentrations. The coefficient of variation (CV%) of concentrations values at the first TDM was 124.7% in critically ill patients and 57.3% in hematologic patients. After dose adjustment in critically ill patients, the proportion with levels outside the therapeutic range decreased to 28.6%. These findings suggest that, despite initial assumptions, isavuconazole exhibits considerable pharmacokinetic variability in specific populations, particularly in critically ill patients, and the findings support the implementation of TDM to optimize antifungal therapy and improve patient outcomes in real-world clinical settings. Full article

Background/Objectives: Dietary advanced glycation end products (dAGEs) have a pro-inflammatory effect and increase oxidative stress, potentially leading to cancer. The aim of this study was to estimate the association between dAGEs consumption and risk and mortality from overall cancer and according to its site. Methods: A systematic search was conducted in Medline, Scopus, Web of Science, and the Cochrane Library from inception to April 2025. The search strategy was conducted according to the PECO structure adapted to this study, as well as the inclusion criteria, in which the population (P) was the adult population, the exposure (E) was the highest level of dAGEs intake, the comparator (C) was the lowest level of dAGEs intake, and the outcomes (O) were the overall cancer risk, cancer risk by site, and cancer mortality. Results across studies were summarised using random effects and fixed effects. Results: Fourteen studies were included in the systematic review. In the random-effects meta-analysis, high dAGEs intake was associated with Hazard Ratio (HR) = 0.99 [95% Confidence Interval (95% CI): 0.98, 1.00] for overall cancer risk. However, although there was no association with breast cancer (BC), there was an association with invasive BC, with HR = 1.14 (95% CI: 1.05, 1.23). In contrast, in other tumours, there were opposite results depending on the site of the cancer. Conclusions: The reduction in cancer risk is not clinically significant. However, high consumption of dAGEs may increase the risk of BC, particularly the invasive BC, which is a challenge for cancer prevention and subsequent mortality. Due to the limited evidence, further studies are needed to confirm the potential impact of dAGEs, as well as other dietary factors that may play a larger role in cancer development. Full article

Background: Childhood cancers represent a heterogeneous group of malignancies and remain one of the leading causes of mortality among children under 14 years of age, ranking second only to accidental injuries, and fourth among individuals aged 15 to 19 years. Despite notable improvements in cure rates, a substantial proportion of patients experience acute or long-term toxicities associated with treatment. Methotrexate (MTX), a chemotherapeutic agent, has been employed effectively for over six decades in the management of pediatric malignancies. High-dose methotrexate constitutes a cornerstone of pediatric cancer therapy; however, its clinical utility is frequently constrained by dose-limiting toxicities. Objectives: This study investigates the impact of genetic polymorphisms in genes involved in nucleotide metabolism, as well as methotrexate and folate metabolic pathways, on treatment-related toxicity in childhood cancer. Methods: Using real-time polymerase chain reaction, 14 polymorphisms across 12 genes were analyzed in a cohort of 107 patients. Toxicity was assessed according to the Common Terminology Criteria for Adverse Events v. 5.0. Results: Multivariate logistic regression analysis revealed that the male sex (p = 0.3) and the AA genotype of MTHFD1 rs2236225 were associated with grade III–IV gastrointestinal toxicity (p = 0.03), while the A allele of MTHFR rs1801133 and the AA genotype of GSTP1 rs1695 were associated with grade I–IV hematologic toxicity (p < 0.01 and p = 0.02, respectively). Conclusions: High-dose methotrexate (HDMTX) is a critical agent in the treatment of childhood cancers. Our findings suggest that genetic polymorphisms within methotrexate and folate metabolic pathways may serve as potential predictive biomarkers of treatment-related toxicity. Full article

Background: In intermediate care, older patients with polypharmacy are vulnerable to drug–drug interactions (DDI) and potentially inappropriate medication (PIM). Aims: To perform a consecutive intervention study to evaluate DDI/PIM. Methods: Clinically-relevant DDI/PIM were identified using AMeLI (electronic medication list) and PRISCUS 2.0 (PIM list). Consecutive patients (standard care group) were screened for DDI/PIM after admission (t0) and again before discharge (t1). In an interim period, physicians received general education about DDI/PIM. Then, consecutive patients (independent clinical pharmacy group) were screened for DDI/PIM after admission (t2). Physicians were then provided with patient-individualized recommendations by a clinical pharmacist to prevent DDI/PIM. The patients were then screened again for DDI/PIM before discharge (t3). Results: In each group, 100 patients were included with data available for evaluation from 97 (standard care group, median age: 78 years [Q25/Q75: 69/84]) and 89 (clinical pharmacy group, 76 years [67/84]). In the standard care group, DDI were identified in 55 (57%) patients after admission (t0) and 54 (56%) before discharge (t1, ARR[t0/t1] = 0.01, NNT[t0/t1] = 100, n.s.). In the clinical pharmacy group, DDI were identified in 32 (36%) after admission (t2; ARR[t0/t2] = 0.21/NNT[t0/t2] = 5, p < 0.01) and 26 (29%) before discharge (t3; ARR[t2/t3] = 0.07/NNT[t2/t3] = 15, n.s.; ARR[t1/t3] = 0.27/NNT[t1/t3] = 4, p < 0.001). PIM were identified in patients at t0: 34 (35%), t1: 35 (36%, ARR[t0/t1] = −0.01/NNH[t0/t1] = 100, n.s.), t2: 25 (26%, ARR[t0/t2] = 0.09/NNT[t0/t2] = 12, n.s.), t3: 23 (24%, ARR[t2/t3] = 0.11/NNT[t2/t3] = 10, n.s.; ARR[t1/t3] = 0.12/NNT[t1/t3] = 9, n.s.). Conclusions: In the standard care group, after admission, many DDI/PIM were identified in older intermediate care patients. Before discharge, their number was hardly influenced at all. General education for physicians led to DDI prevention after admission. In addition, the DDI frequency decreased by providing physicians with patient-individualized recommendations. Full article

Background: Dimethyl fumarate (DMF) and diroximel fumarate (DRF) are two treatments used for multiple sclerosis (MS) that have been shown to be effective in controlling MS patients. DRF was introduced in 2019 with the aim of decreasing the gastrointestinal side effects caused by DMF. Few real-life studies verify the data provided in the clinical trials. Methods: A retrospective descriptive study was conducted on MS patients at the Hospital Universitario Torrecárdenas under treatment with DRF and DMF. Demographic, clinical, and analytical variables were studied and compared between groups. Results: A total of 60 patients were recruited, 30 with each treatment, observing similar baseline characteristics. Fewer gastrointestinal (GI) effects were observed in the DRF group, while more infections were detected in the DMF group. We recorded lower levels in the DRF group, with four cases of moderate-severe lymphopenia in the DRF group vs. none in the DMF group. In addition, we observed a decrease in lymphocytes after the change from DMF to DRF in patients with a change. Conclusions: Our real-life analysis of patients treated with DMF or DRF supports several studies’ findings regarding decreased GI side effects with DRF vs. DMF without decreasing efficacy. However, our data show a greater reduction in lymphocytes in patients with DRF compared to DMF, so more studies are necessary. Full article

Background/Objectives: Post-transplant diabetes mellitus (PTDM) and prediabetes (PreDM) are common after renal transplantation and increase the risk of cardiovascular events and mortality. Compared to immediate-release tacrolimus (IR-Tac), the LCPT formulation, with delayed absorption, offers higher bioavailability and a smoother time–concentration curve, potentially reducing beta-cell stress. Methods: This randomized pilot trial compared de novo immunosuppression with IR-Tac (twice daily) and LCPT (once daily). At-risk recipients (age ≥ 60 years or 18–59 years with metabolic syndrome) were enrolled and followed for 3 months. The primary and secondary outcomes were the incidence of PTDM and PreDM, respectively. Results: 27 patients were randomized to IR-Tac and 25 to LCPT. The incidence of PTDM was comparable between groups [IR Tac: 18.5% (95% CI: 8.2–36.7%) vs. LCPT: 24% (95% CI: 11.5–43.4%); p = 0.7]. Although not statistically significant, the LCPT group exhibited a trend toward a reduction in PreDM incidence [IR-Tac: 40.7% (95% CI: 25–59%) vs. LCPT: 20% (95% CI: 9–39%); p = 0.1]. A sensitivity analysis showed similar results, with no significant differences in cumulative corticosteroid doses or baseline body mass index (BMI) between groups. The LCPT group showed a trend toward higher tacrolimus exposure at the end of the study [trough levels: IR-Tac group 8.3 (6.9–9.2) vs. LCPT group 9.4 (7.4–11.4) ng/mL; p = 0.05)], as well as fewer acute rejection episodes (none vs. three). Delayed graft function was more common in the IR-Tac group (37% vs. 8%; p = 0.01), and the eGFR was lower. Adverse events were comparable between groups. Conclusions: The potential biological activity of LCPT in preventing glucose metabolic alterations in at-risk patients warrants further investigation. Full article

Background/Objectives: Patient care and control of inflammatory disorders, such as psoriasis, can be improved by model-informed precision dosing (MIPD) techniques based on population pharmacokinetic/pharmacodynamic (PK/PD) models. Clinical dose selection decisions based on MIPD strategies need to take account of the uncertainty associated with the individual PK/PD model parameters, which is determined by the quantity of individual observational data collected in clinical practice. Methods: The aim of this study was to propose an approach for personalized dosage regimens of secukinumab (SCK) in 22 Spanish patients with plaque psoriasis, whose severity level was considered moderate to severe, taking into account the uncertainty associated with individual parameters in a population-based PK/PD model. Results: The link between SCK serum concentrations and Psoriasis Area and Severity Index (PASI) scores was explained using an indirect response model. A maximum inhibition (I_max) drug effect model was applied to limit the progression of psoriatic skin lesions within the turnover PD mechanism, which explains the changes in PASI scores during treatment. A first-order remission rate constant for psoriatic lesions (k_out = 0.11 day⁻¹) was estimated. Conclusions: According to the MIPD strategy, 50% of patients would require an optimized regimen and 14% would require an intensified dosage regimen in comparison to current clinical treatment. This research has shown its usefulness as a tool for choosing individualized SCK dosage regimens in patients with long-lasting plaque psoriasis to improve the probability of achieving satisfactory response levels. Full article