The latest medical research on Clinical Pharmacology

Globally, pharmacist-led anticoagulation services have improved patient outcomes in secondary and tertiary care settings. However, there is a paucity of literature about establishing such services within primary care settings.

This study explored key informants' perceptions regarding the systemic and procedural factors influencing development and implementation of a pharmacist-led anticoagulation service in a primary care setting.

A descriptive qualitative study was conducted at Qatar's largest primary healthcare institution, the Primary Health Care Corporation (PHCC). Selected key informants, including healthcare center managers, pharmacy leads, physician leads and primary care physicians with cardiology privileges, were purposively recruited. Semi-structured interviews were guided by the Consolidated Framework for Implementation Research (CFIR) and analyzed using framework analysis.

Elven key informants were interviewed. The participants expressed confidence in the feasibility and effectiveness of implementing anticoagulation service in primary care to address patients' needs. Key factors (mapped to CFIR domains) included ensuring pharmacist competency (Characteristics of Individuals), establishing effective internal and external communication (Inner and Outer Setting), and addressing staffing shortages (Inner Setting). Participants also emphasized on developing standardized operational protocols and training programs (Process), as well as integrating services with secondary care (Outer Setting). Despite challenges such as staffing, participants believed the service would effectively address patient needs if adequately supported.

The implementation of pharmacist-led anticoagulation services in primary care settings was identified as both feasible and essential for improving patient outcomes. The insights from this study can inform future initiatives aimed at enhancing anticoagulation management in primary care settings.

Retinitis pigmentosa (RP) is a hereditary retinal disorder that gradually leads to vision loss due to photoreceptor cell degeneration. This study aims to investigate the clinical features and genetic underpinnings of RP within a large Iranian family. Our focus centered on mutations in the NR2E3 gene, which plays a critical role in the development and maintenance of the retina.

Twenty-five family members showed symptoms of RP, and fourteen of them underwent clinical examinations conducted by geneticists and ophthalmologists. The DNA samples of five individuals diagnosed with RP from the family were subjected to whole-exome sequencing (WES) as part of the study. The candidate variant identified through WES was subsequently confirmed using bidirectional sequencing in additional family members. Additionally, in silico analysis, including molecular modeling, protein-protein docking, and molecular dynamics simulation (MD), was employed to assess potential pathogenic effects associated with the candidate variants.

Ophthalmic examination revealed night blindness, which is a common symptom among affected individuals. Genetic analysis identified a homozygous missense variant (c.934G>A/p.R311Q) in NR2E3 exon 6, which co-segregates with other affected family members. Furthermore, molecular docking analysis indicated potential disruption in the binding affinity between NR2E3 and NR1D1 proteins. In-depth, molecular dynamics analysis, considering parameters such as RMSD, RMSF, and hydrogen bonding, revealed notable differences between normal and mutant protein complexes.

Exploring the molecular interaction between NR2E3 and NR1D1 provides new insights into the pathogenic mechanism of the p.R311Q mutation in RP.

To evaluate the effect of a clinician-designed digital notification system on the use of intravenous paracetamol during a medication shortage.

An in-house digital notification platform was designed through multidisciplinary collaboration. A 4-week pre- and post-implementation methodology was employed to evaluate the effect of the intervention.

There was significantly lower use of intravenous paracetamol in the post-implementation period compared to the pre-implementation period (median 80 doses per day, interquartile range 58 to 93, vs 94, interquartile range 83 to 122, P < .001).

Multidisciplinary clinician-designed digital notification platforms may assist during times of medication shortage.