The latest medical research on Pharmacist
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Request AccessCost-effectiveness analysis of first line pembrolizumab monotherapy for high programmed cell death ligand 1 expressed, advanced non-small cell lung cancer in Japan.
International Journal of EpidemiologyPembrolizumab monotherapy significantly extends progression-free and overall survival compared to platinum-based chemotherapy for advanced non-small cell lung cancer (NSCLC), but also has a significant impact on medical costs.
To clarify the health economic evidence for selecting the first-line treatment for patients with stage IV advanced NSCLC with a programmed cell death ligand 1 tumor proportion score of 50% or greater in Japan, we assessed the cost-effectiveness of pembrolizumab monotherapy compared with that of platinum-based chemotherapy.
Using a Markov model, the study simulated three health states for patients, based on clinical data and utility values from KEYNOTE-024. Transition probabilities were estimated exponentially. Direct medical costs were calculated according to the 2022 National Health Insurance Medical Fee Points and Drug Price Standards. The outcomes measured included life years, quality-adjusted life years, and incremental cost-effectiveness ratio, with sensitivity analysis performed to evaluate the effect of uncertainties.
Pembrolizumab led to an additional 1.58 life years and 1.23 quality-adjusted life years at an additional cost of 7,009,888 Japanese yen (48,448 U.S. dollars [USD]), resulting in incremental cost-effectiveness ratio of 4,436,638 Japanese yen (30,663 USD) per life year and 5,699,096 Japanese yen (39,388 USD) per quality-adjusted life year. Pembrolizumab was deemed cost-effective under a threshold of 7.5 million Japanese yen (51,835 USD) per quality-adjusted life year.
Pembrolizumab monotherapy is a cost-effective option for the first-line treatment of advanced NSCLC with high programmed cell death ligand 1 expression in Japan, providing valuable health economic evidence for treatment selection.
Patterns, circumstances and risk factors associated with non-fatal substance overdose in a cohort of homeless population: an observational study.
International Journal of EpidemiologyNon-fatal overdoses frequently precede fatal overdoses, thus identifying risk factors for non-fatal overdoses could help develop strategies to prevent substance related deaths.
This study aimed to identify patterns, circumstances and risk factors leading to non-fatal substance overdose in people experiencing homelessness.
All recorded cases of non-fatal substance overdose from a population of people experiencing homelessness registered at a specialist homelessness primary care centre in England were identified using electronic medical records. Overdose details and patient characteristics were extracted. The heterogeneity between variables in people with and without a recorded non-fatal overdose were tested and multivariable logistic regressions were used to identify the risk factors of non-fatal overdoses.
From the 1221 registered patients, 194(16%) were identified as having had a non-fatal overdose with 428 overdoses between them. Half were polypharmacy events with the main substances of overdose being: heroin, paracetamol, benzodiazepines, cocaine, antipsychotics, SSRIs and synthetic cannabinoids. Risk of non-fatal overdose was greater in females, white ethnicity, ages 36-45, and in those with a recorded use of tobacco, alcohol or illicit substance use. Chronic physical and mental health conditions increased the risk of non-fatal overdose including respiratory conditions, blood borne viruses, migraines, anxiety and depression.
With a high number of non-fatal overdoses within this population, identifying individuals at risk based on the factors identified in this research could enable primary care providers to apply prevention actions such as overdose awareness and naloxone provision to avoid drug harm and deaths. Future work should explore the role of chronic physical conditions and their treatment on non-fatal overdose risks.
A consolidated framework for implementation research (CFIR) guided exploration of key informant perspectives on establishing a pharmacist-led anticoagulation service in primary care: a qualitative study.
International Journal of EpidemiologyGlobally, 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.
Knowledge, attitudes, and practices of community pharmacists providing over-the-counter emergency hormonal contraception: a scoping review.
International Journal of EpidemiologyReducing the rate and impact of unintended pregnancy through effective contraception is a public health goal. Since deregulation, globally, ease of access to community pharmacists has enabled them to play a key role in the provision of emergency hormonal contraceptive pills (ECP). The aim of this scoping review is to explore pharmacists' overall knowledge of and attitudes and practices towards the provision of emergency contraception.
A systematic literature search for the period from 1999 to 2023 was conducted using Scopus, Medline (Ovid), CINAHL, Emcare, Web of Science, and Google Scholar. Keywords such as emergency contraception, emergency contraceptive, morning after pill, plan B, pharmacist, community pharmacist, and pharmacy were applied. Articles published only in English that described the knowledge, attitudes, and practices of community pharmacists providing emergency contraception were included in this review.
Twenty studies met the inclusion criteria. Despite positive attitudes towards the provision of ECP, there is a clear deficit in both the knowledge and counselling practices of pharmacists, with some pharmacists lacking an open attitude towards the supply of ECP to adolescents and third parties. Usage of a private counselling area ranged from 0% to 90% highlighting privacy for patients seeking ECPs is lacking during consultations. In countries where practice guidelines are available, these are often not being optimally utilized.
This review has highlighted gaps in pharmacists' knowledge and counselling practices, demonstrating shortcomings in pharmacists' education, training, and application of professional practice guidelines. Future research on ECP guidelines is recommended to improve implementation and usability in practice.
Donepezil and Memantine-Induced Second-Degree Atrioventricular Block: A Case Report.
Hospital PharmacyDonepezil and memantine are second-generation antipsychotics widely used in the management of mild to moderate Alzheimer's disease. These drugs are...
Use of 400 µg/mL Peripheral Phenylephrine Infusions During Anesthesia: A Safety Initiative.
Hospital PharmacyDuring a general anesthetic case, a patient was administered a 400 µg/mL infusion of phenylephrine as opposed to the 40 µg/mL solution typically us...
Pharmacy-Physiotherapy Interprofessional Education and Practice.
Hospital PharmacyInterprofessional education (IPE) is an educational technique in which tutors and students from several healthcare disciplines, such as pharmacy an...
Medication shortage behaviour change with multidisciplinary clinician-designed digital notification intervention.
International Journal of EpidemiologyTo 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.
Model-informed precision dosing of vancomycin in clinical practice: an intervention development study.
International Journal of EpidemiologyCurrent guidelines recommend dosing vancomycin based on the area under the concentration time curve (AUC) to maximise efficacy and minimise the risk of nephrotoxicity. The preferred approach to AUC-guided therapy is to apply model-informed precision dosing (MIPD). However, the adoption in clinical practice has been slow.
We aimed to develop an intervention, including a standardised MIPD workflow and an implementation plan for vancomycin AUC-guided dosing, in a Swedish tertiary hospital.
The intervention was developed in a framework-guided process. The design phase included stakeholder feedback (nurses, pharmacists, physicians), local data collection and feasibility testing of intervention components with parallel consideration of implementation aspects. The hypothesised relationships between the different components, implementation strategies and the mechanism of action resulting in expected outcomes were represented by a logic model.
The final intervention consisted of a workflow for MIPD, with defined roles and responsibilities, as well as processes for data and information transfer. Details were provided in supportive documents; an instruction on therapeutic drug monitoring (TDM) sampling and documentation for nurses, and a detailed dosing software instruction for MIPD consultants and clinical pharmacists. Activities to facilitate implementation included the development of a local clinical routine for vancomycin dosing, staff training and recurring MIPD rounds.
An intervention for MIPD, with an implementation plan for AUC-guided dosing of vancomycin, was developed for a tertiary hospital setting. The process can be used as guidance for other institutions with similar context wishing to initiate MIPD.
Evaluating biosimilars: safety, efficacy, and regulatory considerations in clinical studies.
International Journal of EpidemiologyBiosimilars are a rapidly growing area of clinical research, yet they encounter significant challenges, especially in emerging markets where regula...
Appropriateness of intravenous fluid prescriptions in hospitalised patients: a point prevalence study.
International Journal of EpidemiologyInappropriate use of intravenous (IV) fluids results in fluid overload, electrolyte disturbances, and increased costs.
To describe IV fluid prescribing and its appropriateness in hospitalised patients.
A point prevalence study was conducted at two sites (academic and general) of a tertiary care hospital in Belgium. All inpatients (except those in the operating theatre) and all IV fluids prescribed during a 24-h period were analysed. Data collected included type, rate and volume administered. Each IV fluid was classified by indication (i.e., resuscitation/replacement, maintenance, catheter patency management, drug administration). Appropriateness was assessed using predefined criteria and validation by attending clinicians.
IV fluids were administered to 60% (297) of patients, with a median of 3 [IQR 0.5-6] IV fluid bags per patient and a median daily volume of 1000 ml [IQR 100-1550]. Amongst the 1162 IV fluid prescribed bags, 61.2% (712) were for drug administration, 22.1% (257) for catheter patency, 9.7% (112) for maintenance and 7.1% (82) for replacement/resuscitation. Inappropriate use was found for 56.9% (169) of patients with an IV fluid, representing a median volume of 300 ml per patient [IQR 10-500], and median costs of 4.60 € per patient [IQR 0.4-6.7].
Inappropriate IV fluid use is frequent in hospitalised patients, and results in significant costs. Optimisation strategies are needed.
Rural pharmacist and consumer perspectives of expanded pharmacy services to address inequity in accessing health services.
International Journal of EpidemiologyAustralians living in rural and remote communities have inadequate access to health services, contributing to poorer health outcomes compared to their metropolitan counterparts. This study investigated consumers' and pharmacists' perspectives of expanded pharmacy services in rural and remote communities in Australia. It aims to identify the role of the pharmacist in addressing the inequity of access to healthcare through the provision of expanded services in rural and remote practice.
A concurrent parallel mixed-methods study was undertaken in rural Western Queensland, Australia to include a survey of 167 consumers and in-depth interviews with 10 pharmacists. Quantitative data analysis employed descriptive statistics and chi-square tests, while qualitative data were analysed thematically against the constructs of the Diffusion of Innovations Theory.
Consumers indicated that they would like to access weight management services (53%), whereas pharmacists thought it was important to offer respiratory clinics and services. Both pharmacists and consumers would like to see diabetes checks (30% and 56%, respectively) and vision, hearing, and ear checks (40% and 53%, respectively) implemented as services in community pharmacies. Most consumers (97%) believe pharmacists have the skills and knowledge to deliver expanded services and in doing so, they would improve the overall health of the community. Pharmacists reported staffing availability, workload and time constraints, cost, and jeopardizing inter-professional relationships as barriers to implementing expanded services.
Consumers were supportive of pharmacists working to their full scope of practice to provide expanded services, whereas pharmacists, while open to the idea, highlighted that there were barriers to overcome.
