Drug Information Research Articles

Clinical pharmacy and telemedicine: an opportunity to improve epilepsy management.

Clinical pharmacy, as defined by the European Society of Clinical Pharmacy, is a comprehensive professional practice encompassing all pharmacist profiles regardless of the setting. It focuses on promoting optimal drug utilization for patient-centric clinical outcomes. Telemedicine leverages information and communication technologies for remote healthcare delivery, bridging geographical gaps. The integration of clinical pharmacy and telemedicine is crucial in modern healthcare paradigms, especially for patients with chronic illnesses. In 2021, marketing authorization was granted for cenobamate as adjunctive treatment for focal-onset seizures with or without secondary generalization in adults with epilepsy who have not been adequately controlled despite a history of treatment with at least two antiepileptic medicinal products. This review emphasizes the synergistic role of clinical pharmacists and neurologists in utilizing telemedicine for patient counselling, drug information dissemination, adverse drug reaction surveillance, and personalized medication management within the context of epilepsy care. This integration could enhance patient safety, therapeutic outcomes and address socio-economic challenges faced by chronic patients.

Retrospective analysis of adverse drug reaction enquiries to a hospital drug information service: lessons to be learned to increase in-hospital drug safety.

Adverse drug reactions (ADRs) are a major drug safety concern and a frequent topic of enquiries to hospital drug information services. Our goal was to analyse these enquiries regarding background, complexity, nature of ADR, and involved drug classes to improve in-hospital drug safety. Retrospectively, ADR enquiries to a German university hospital pharmacy drug information 2018-2022 were analysed regarding enquirer (profession, medical specialty) and enquiry details (drugs, suspected ADR/enquiry prior to drug initiation, ADR system organ class, probable cause identified, and enquiry complexity). Of 543 enquiries, 516 (95%) were asked by physicians, 493 (91%) patient-specific, 390 (71%) on suspected ADRs, and 153 (28%) prior to drug initiation. Enquiries originated frequently from internal medicine (74/13.6%), paediatrics (71/13.1%), neurology (70/12.9%), and haemato-oncology (62/11.4%). Most frequent ADRs were haematologic (94/17%) and hepatic (72/13%). The median number of drugs per enquiry was three (range 0-37), 209 (38%) enquiries referred to one specific drug, 165 (30%) concerned ≥11 drugs. A probable cause for suspected ADRs was identified in 75 (36%) enquiries concerning one drug and 155 (94%) with ≥11 drugs. Most frequent drugs were antineoplastic (54/25.8%), nervous-system-drugs (42/20.1%), and anti-infective (40/19.1%). Most enquiries (342/63%) were complex (multiple/specialist resources). Enquiries were usually asked by physicians referring to suspected ADRs in specific clinical situations. A probable cause was identified in many cases pointing to a direct positive impact on patient care. Enquiries prior to drug initiation should be encouraged to increase drug safety. Information on main ADR effects and drug classes helps with targeted counselling.

Mapping medication selling practices at nonpharmacy outlets during the COVID-19 pandemic: an example of Indonesia.

Nonpharmacy outlets are common medication suppliers in Indonesia, yet little is known regarding their practices. This study aimed to evaluate the medication selling practices occurring in kiosks and minimarkets during the coronavirus disease 2019 pandemic. A cross-sectional study included all minimarkets (N = 101) and a convenience sample of kiosks (a minimum sample size, N = 67) in District X, Indonesia. A validated tool was used to collect data on the characteristics of kiosks/minimarkets and their medication selling practices (i.e. drug management and drug information). A sample of 67 kiosks and 52 minimarkets (response rate 51.5%) consented to participate in this study. Kiosks and minimarkets generally stocked nonprescription drugs, particularly cough and/or common cold products or analgesic-antipyretics; while >90% of kiosks and 15.4% of minimarkets provided prescription medicines. Medications in kiosks and minimarkets were mainly obtained from pharmacies (94.0% vs. 17.0%, respectively) or pharmaceutical wholesale representatives (68.7% vs. 96.0%, respectively). Most minimarkets or kiosks satisfied drug storage standards (100.0% vs. 88.1%, respectively). During the previous week, >80% of kiosks and minimarkets reported purchases of nonprescription drugs, and approximately 5% reported sales of prescription drugs. No drug information was provided by kiosk or minimarket staff. Minimarkets and kiosks may improve access to basic medications, but no information is provided regarding their use. These outlets should be licensed and policed to ensure the range and quality of drugs, and information provided to the Indonesian community is appropriate.

Accessibility of drug information on ocular drug product websites in the United States

Accessibility of drug information on ocular drug product websites in the United States

Patients' Identification, Management and Prevention of Adverse Drug Reactions: A Cross-Sectional Survey of Patients with Severe Adverse Drug Reactions.

Background: Few studies have been conducted on how patients identify, manage, and prevent severe adverse drug reactions (ADRs). This study aimed to explore the reasoning that patients use to identify symptoms of severe ADRs and the methods they employ to manage and prevent them. Methods: A cross-sectional survey using structured telephone interviews was administered to patients with a self-assessed severe ADR and to patients with serious skin ADRs from a hospital medical record database (in-patient and out-patient) from 1 September 2016 to 1 September 2019. Patients identified via the medical records were asked to assess their ADR for severity, and only patients that rated their ADR as severe were followed up with a telephone interview. Structured telephone interviews were conducted with respondents by a research pharmacist and audio-recorded. Results: A total of 722 patients with a severe ADR were identified, with 300 completing the interview (41.6%). The most frequently cited reasons for classifying ADRs as severe was worsening ADR symptoms (58.3%), severe ADR symptoms (44.4%), and ADR symptoms interfering with their life (36.4%). Only severe ADR symptoms were significantly different between the questionnaire and the medical records database groups (p = 0.007). The most frequent method of ADR management was discontinuation of drug by physicians (88.3%). About 79.0% of patients stated that they increased their carefulness when using other drugs after experiencing ADRs. The main method patients used to prevent ADRs was informing healthcare professionals (HCPs) about their drug allergy history (65.7%). Conclusions: Worsening ADR symptoms were often used to identify severe ADRs. However, HCPs were mainly responsible for the management and prevention of severe ADRs. Increasing awareness of ADRs by HCPs, and providing additional drug information, may improve patient safety.

Factors Determining Quality of Drug Information by Hospital Pharmacies-Results from Five-Year Annual Quality Assessment.

Drug information (DI) provided by hospital pharmacies aims to promote rational and safe drug therapy. While quality assessment for this task is recommended, more knowledge on the factors determining the quality is needed. We aimed to evaluate the impacts of different factors on the quality of DI provided by hospital pharmacies to healthcare professionals. Retrospectively, answers on fictitious enquiries about annual DI tests for German hospital pharmacies over five years were evaluated for content-related and structural requirements. Multivariate analysis was performed for the impact of the enquiry complexity, DI organization (specialized DI center; pharmacist responsible per day; DI on top of other routine tasks), and quality measures (second look; experience of answering pharmacist in DI/on ward; use of documentation database). In 2017-2021, 45, 71, 79, 118, and 122 hospital pharmacies participated. The enquiry complexity had a statistically significant impact on the content-related quality, with poor results for a higher complexity (years 2018/2021, OR 0.25/0.04, p < 0.01). The DI centers achieved better results regarding content-related quality than for a pharmacist responsible per day (OR 0.76/p = 0.65) or DI on top of routine tasks (OR 0.35/p = 0.02). The DI centers scored better in structural quality. The second look showed an overall trend of a better content-related and structural quality. In conclusion, specialized DI centers and second looks are recommended as quality-improving measures. Training for answering complex enquiries should be intensified.

Assessing GPT-4's Performance in Delivering Medical Advice: Comparative Analysis With Human Experts.

Accurate medical advice is paramount in ensuring optimal patient care, and misinformation can lead to misguided decisions with potentially detrimental health outcomes. The emergence of large language models (LLMs) such as OpenAI's GPT-4 has spurred interest in their potential health care applications, particularly in automated medical consultation. Yet, rigorous investigations comparing their performance to human experts remain sparse. This study aims to compare the medical accuracy of GPT-4 with human experts in providing medical advice using real-world user-generated queries, with a specific focus on cardiology. It also sought to analyze the performance of GPT-4 and human experts in specific question categories, including drug or medication information and preliminary diagnoses. We collected 251 pairs of cardiology-specific questions from general users and answers from human experts via an internet portal. GPT-4 was tasked with generating responses to the same questions. Three independent cardiologists (SL, JHK, and JJC) evaluated the answers provided by both human experts and GPT-4. Using a computer interface, each evaluator compared the pairs and determined which answer was superior, and they quantitatively measured the clarity and complexity of the questions as well as the accuracy and appropriateness of the responses, applying a 3-tiered grading scale (low, medium, and high). Furthermore, a linguistic analysis was conducted to compare the length and vocabulary diversity of the responses using word count and type-token ratio. GPT-4 and human experts displayed comparable efficacy in medical accuracy ("GPT-4 is better" at 132/251, 52.6% vs "Human expert is better" at 119/251, 47.4%). In accuracy level categorization, humans had more high-accuracy responses than GPT-4 (50/237, 21.1% vs 30/238, 12.6%) but also a greater proportion of low-accuracy responses (11/237, 4.6% vs 1/238, 0.4%; P=.001). GPT-4 responses were generally longer and used a less diverse vocabulary than those of human experts, potentially enhancing their comprehensibility for general users (sentence count: mean 10.9, SD 4.2 vs mean 5.9, SD 3.7; P<.001; type-token ratio: mean 0.69, SD 0.07 vs mean 0.79, SD 0.09; P<.001). Nevertheless, human experts outperformed GPT-4 in specific question categories, notably those related to drug or medication information and preliminary diagnoses. These findings highlight the limitations of GPT-4 in providing advice based on clinical experience. GPT-4 has shown promising potential in automated medical consultation, with comparable medical accuracy to human experts. However, challenges remain particularly in the realm of nuanced clinical judgment. Future improvements in LLMs may require the integration of specific clinical reasoning pathways and regulatory oversight for safe use. Further research is needed to understand the full potential of LLMs across various medical specialties and conditions.

Drug-Drug Interactions Involving High-Alert Medications that Lead to Interaction-Associated Symptoms in Pediatric Intensive Care Patients: A Retrospective Study.

Children treated in a pediatric intensive care unit (PICU) often receive several drugs together, among them drugs defined as high-alert medications (HAMs). Those drugs carry a high risk of causing patient harm, for example, due to a higher potential for interactions. HAMs should therefore be administered with caution, especially in a PICU. The objective of the current study was to identify drug-drug interactions involving HAMs that increase the risk of interaction-associated symptoms in pediatric intensive care. In a retrospective study, we analyzed the electronic documentation of patients hospitalized for at least 48 h in a general PICU who received at least two different drugs within a 24-h interval. We assessed potential drug-drug interactions involving HAM on the basis of the two drug information databases UpToDate and drugs.com. Furthermore, we analyzed whether symptoms were observed after the administration of drug pairs that could lead to interaction-associated symptoms. For drug pairs involving HAM administered on at least 2% of patient days, and symptoms observed at least ten times after a respective drug pair, we calculated odds ratios, 95% confidence intervals, and p-values by using a univariate binary logistic regression. Among 315 analyzed patients, 81.3% (256/315) received drugs defined as high-alert medication for pediatric patients. Those high-alert medications were involved in 20,150 potential drug-drug interactions. In 14.0% (2830/20,150) of these, one or more symptoms were observed that could be a possible consequence of the interaction, resulting in 3203 observed symptoms affecting 56.3% (144/256) of patients receiving high-alert medication. The odds ratios for symptoms observed after a drug-drug interaction were increased for eight specific symptoms (each p ≤ 0.05), especially hemodynamic alterations and disturbances of electrolyte and fluid balance. The odds ratio was highest for decreased blood pressure observed after the administration of the drug pair fentanyl and furosemide (OR 5.06; 95% confidence interval 3.5-7.4; p < 0.001). Increased odds ratios for specific symptoms observed after drug-drug interactions resulted from eight combinations composed of eight different drugs: digoxin, fentanyl, midazolam, phenobarbital, potassium salts and vancomycin (high-alert medications), and the diuretics furosemide and hydrochlorothiazide (non-high-alert medications). The resulting drug pairs were: potassium salts-furosemide, fentanyl-furosemide, vancomycin-furosemide, digoxin-furosemide, digoxin-hydrochlorothiazide, fentanyl-phenobarbital, potassium salts-hydrochlorothiazide, and midazolam-hydrochlorothiazide. In a cohort of PICU patients, this study identified eight specific drug pairs involving high-alert medications that may increase the risk of interaction-associated symptoms, mainly hemodynamic alterations and electrolyte/fluid balance disturbances. If the administration of those drug pairs is unavoidable, patients should be closely monitored.

Android-Based Drug Information Application Using Augmented Reality Technology

The use of Augmented Reality technology in the pharmaceutical sector, particularly in pharmacies, has introduced significant innovations in providing drug information to consumers. AR applications can help healthcare workers and patients better understand drug use through three-dimensional visualization superimposed on the real environment. Observations at Sultan Abdul Aziz Syah Peureulak Hospital indicate that 70% of patients still experience confusion regarding the drug information provided by pharmacy staff. This difficulty is caused by the complexity of the information, lack of personal interaction, or low health literacy. To address this problem, the Android-based Mediscan application was developed using AR technology. This application utilizes Unity and Vuforia Engine software to present drug information visually in card form via the smart device screen. Users can point the camera at a particular drug and receive complete information regarding general indications, dosage, drug class, contraindications, and side effects. This research aims to develop the Mediscan application, calculate the level of patient understanding, measure consumer satisfaction, and evaluate the impact of using AR in presenting drug information. The System Development Life Cycle methodology with the Waterfall model was used in this research. The results show that AR technology can be implemented in Android-based applications to present drug information visually and interactively. The majority of patients feel more informed and gain a better understanding of the medication they are taking. AR technology in the Mediscan application improves user experience, supports the education and training of medical personnel and patients, and enhances the quality of healthcare services in hospitals. This application also makes it easier for medical personnel and pharmacists to convey drug information more effectively and efficiently.

ChatGPT and other Chatbots in Psychiatry

Aim: Artificial intelligence (AI) is making significant inroads into the field of psychiatry, offering new tools and applications. ChatGPT, a specific chatbot, is at the forefront of this digital revolution. AI’s use in psychiatry ranges from identifying psychiatric symptoms, predicting treatment responses, and improving medication adherence to assisting in patient education, monitoring, and bridging gaps in mental health care. Materials and Methods: This review used a literature study method. Results: ChatGPT functions as a clinical decision support tool. It can analyse patient data and provide diagnostic insights, recommend evidence-based treatments, and offer drug information. It has demonstrated proficiency in generating summaries from medical records, saving clinicians time and enabling them to focus on patient care. Additionally, chatbots like ChatGPT serve as therapist assistants, offering emotional support between therapy sessions and potentially conducting psychotherapy. Studies have shown positive outcomes, with chatbots reducing depression, anxiety symptoms, and providing 24/7 availability for crisis situations. Users find them non-judgmental and comfortable for discussing sensitive issues. Despite their potential, chatbots have limitations, such as the risk of incorrect or biased information due to their training data. They lack genuine understanding, creativity, and the ability to clarify user input. Ethical considerations regarding responsibility and data usage are paramount. Conclusion: AI, particularly ChatGPT, holds substantial promise in modern psychiatry, enhancing diagnostics, patient education, monitoring, and therapeutic support. Its integration into everyday psychiatric practice requires careful use, continuous oversight, and ethical considerations. Psychiatrists must become more familiar with AI tools to leverage their benefits in patient care.

Measuring pharmacy clinical workload in the emergency department: Current status and a plan for action

BackgroundInpatient pharmacy productivity workload ratios historically encompass dispensing functions including numbers of medication orders verified, dispensed, and billed for and full-time equivalents (FTEs) but do not include pharmacy clinical activities. Clinical pharmacy activities are difficult to capture because they generally require manual documentation and vary among health systems. The emergency medicine pharmacists’ (EMPs) role adds additional complexity to capturing clinical activities given that bedside response and verbal recommendations are difficult to capture outside of manual documentation. It is unknown how many health systems use EMP-specific workload metrics. ObjectivesThe purpose of our survey was to determine the percentage of hospital pharmacies that use EMP-specific workload metrics, to describe workload metrics used by EMPs and to quantify time spent on clinical activities, and to describe methods for implementing EMP metrics. MethodsA 13-item questionnaire was developed, pretested, and sent to EMPs practicing in hospitals in the United States through 2 EMP national committee e-mail listservs. Survey completion online included questions on hospital characteristics, number of EMP FTEs, clinical services provided and time spent on these tasks, and current workload metrics used. ResultsFull responses to the survey were received from 100 pharmacists, with an overall response rate of 9.8%. Workload metrics specific to EMP activities were used by 15.1% of responders. Workload metrics were used but not tailored to EMP activities for 43% of responders, and 41.9% responded that no metrics were used whatsoever. Ten responders provided commentary on types of EMP activities tracked, which included bedside response for critical patients, culture callback, drug information and dosing, time to antibiotic administration, and medication histories. No universal software for metric tracking was identified. ConclusionA survey of EMP clinical services and workload metrics indicated that although 43% of responders use non-EMP-specific metrics, only 15.1% reported workload metrics that capture EMP clinical activities.

Assessment of Medication Labeling Compliance in Outpatient Pharmacy: A Study in Riyadh, Saudi Arabia

Abstract This study assessed outpatient medication labels in 19 hospitals in Riyadh, Saudi Arabia, focusing on critical information necessary for safe and effective medication use. The study utilized a structured observation form based on guidelines from the Saudi Food and Drug Authority and the Institute for Safe Medication Practices. The form included indicators related to label identification, instructions, and layout. Compliance rates for each indicator were calculated, revealing varying levels of adherence across different hospitals. High compliance rates were observed for indicators such as the date of dispensing (100%), directions of use (100%), and typing directions in Arabic (100%). However, lower compliance rates were noted for physician and pharmacist information, drug information, and additional medication details, with rates ranging from 0 to 78.9%. Specifically, the inclusion of physician and pharmacist registration numbers had a compliance rate of 0%. The study highlighted significant gaps in standardizing medication labels, emphasizing the need for including essential information such as total quantity dispensed, number of refills, warning labels, medication indication, and storage conditions. Additionally, the use of barcodes, hospital logos, and Tallman letters was found to be inconsistent. In conclusion, the findings underscore the necessity for standardizing outpatient medication labeling practices to improve patient safety and medication management. This study calls for collaborative efforts, knowledge sharing, and the implementation of best practices to achieve consistent and accurate medication labeling in Saudi Arabia.

Discussion of the classification of pediatric drug clinical trials in children's hospitals in China.

This study aimed to gain insights into pediatric clinical trials conducted in children's hospitals in China and provide valuable references for the development of children's hospitals and the research and development of pediatric drugs. A comprehensive search was performed on the Chinese Clinical Trial Registry (Chi CTR) and ChinaDrugTrials.org.cn to collect information on all clinical trials involving subjects under 18 years, including those conducted in children's hospitals. The retrieval period was extended until 31 December 2022. A total of 459 pediatric clinical trials were collected, comprising 299 from Chi CTR and 160 from the Drug Clinical Trial Registration and Information Publicity Platform (Information Platform). Post-marketing drug studies and phase III clinical trials accounted for the majority of research stages. These trials covered a wide range of diseases/systems, with a particular focus on respiratory system disorders, tumors, endocrine disorders, and nutritional or metabolic diseases. Chemical drugs constituted the most extensively studied category, while traditional Chinese medicine/natural drugs received comparatively less attention. Clinical trial activities were primarily geographically focused on the eastern coastal regions of China, with multicenter trials being the most predominant. Ethics committee approval was obtained for 427 studies. The pediatric clinical trials conducted by children's hospitals in China have shown an overall upward trend; however, there is limited research focusing on traditional Chinese medicine, along with significant regional and institutional imbalances. Furthermore, there is still room for improvement regarding ethical review processes. It is recommended that children's hospitals enhance their scientific research capabilities while optimizing resource allocation to meet medical service demands effectively. Additionally, fostering more research-focused children's hospitals will contribute to the high-quality development of children's health in China.

Evaluation of Adverse Drug Events of Remdesivir for the Treatment of COVID-19 in Patients Contacting the 13-Aban Pharmacy Drug and Poison Information Center

Background: One of the FDA-approved treatments for COVID-19 is remdesivir. In this study, we investigated adverse drug events (ADEs) of remdesivir in COVID-19 patients who contacted 13-Aban pharmacy’s drug and poison information center (DPIC). Methods: In this study, data of patients receiving remdesivir who contacted the 13-Aban pharmacy’s DPIC between April 2021 and May 2022 were extracted. For the evaluation of potential ADEs, we reviewed all contacts related to remdesivir recipients. Results: Out of 223 patients enrolled, 108 (48.40%) developed 120 ADEs. Elevated liver transaminase levels (26.67%) were the most common ADE, followed by weakness (7.5%), nausea, and vomiting (7.5%). The causality assessment of ADE using the Naranjo scale revealed that 41.67% were probable and 58.33% were possible. Conclusion: Based on the results of this study, hepatic dysfunction was the most prevalent ADE among remdesivir recipients; thus, in order to ensure safe use of remdesivir, patients should be closely monitored for this ADE.

Blockchain technology in drug traceability

Currently, Drug Counterfeiting is biggest challenge pharma industry is encountering as high market demand of the drugs and due to high profit margin. The lack of data transparency and lack of traceability also lured black market for the counterfeiting which impact Pharma organization and putting the life of the patient in danger. Through the Drug Supply chain substantial portion of the counterfeit drug are getting injected and distributed through healthcare supply chain network, so supply chain is playing vital role in the drug distribution and impact the patient life. Through digitalization in the healthcare sector, Blockchain technology give platform with groundbreaking results via providing the system for the drug traceability with consideration of the critical requirement of transparency, privacy, authenticity with involving any third party. In Blockchain technology, each distribution partner registered to maintain transparency with the drug information. Real time transfer the information about the change of ownership with date and time in forms of blocks giving the visibility to all the partners real time with authenticity of drugs. This article will give the information about the use of the block chain technology benefit to the pharmaceuticals industry and traceability and trackability information of drugs from end-to-end of the pharmaceutical supply chain.

Persepsi Mahasiswa Pendidikan Profesi Apoteker terhadap Peran Tenaga Kesehatan

Pharmacist Professional Education students are one of the health workers who will collaborate with other health workers. The perception and understanding of the role of each health professional influences health-professional collaboration. Interprofessional Education is one strategy to provide learning and experience for students so that they can collaborate early on and understand the roles of other health workers in an effort to collaborate effectively when practicing later. This study aimed to identify students' perceptions of health workers' role in their profession and other health professions. This research is descriptive and observational with a cross-sectional design. The research subjects were active Pharmacist Professional Study Program FMIPA ULM Batch X students, with 40 respondents. The instrument in this study was a questionnaire distributed online via Google Forms. The research data were subsequently descriptively analysed, tabulated, and presented as a percentage. The results showed that 40 respondents, 80% women, 80% of respondents did not have work experience, and 60% of respondents had family members who worked as health workers. Respondents' perceptions of the role of health workers showed that 97.5% (39) of respondents had the perception that pharmacists had a role as a source of drug information. The perception that doctors, nurses, and pharmacists share the same role in monitoring the response of patients receiving intravenous therapy and making dose adjustments was 75% (30), attending regular community health council meetings was 77.5% (31), and documenting professional activities in patients' medical records was 72.5% (29). Pharmacist education students have different perceptions of the role of health workers and believe that there is a collaboration between health workers in certain activities.

Data Flow Construction and Quality Evaluation of Electronic Source Data in Clinical Trials: Pilot Study Based on Hospital Electronic Medical Records in China.

The traditional clinical trial data collection process requires a clinical research coordinator who is authorized by the investigators to read from the hospital's electronic medical record. Using electronic source data opens a new path to extract patients' data from electronic health records (EHRs) and transfer them directly to an electronic data capture (EDC) system; this method is often referred to as eSource. eSource technology in a clinical trial data flow can improve data quality without compromising timeliness. At the same time, improved data collection efficiency reduces clinical trial costs. This study aims to explore how to extract clinical trial-related data from hospital EHR systems, transform the data into a format required by the EDC system, and transfer it into sponsors' environments, and to evaluate the transferred data sets to validate the availability, completeness, and accuracy of building an eSource dataflow. A prospective clinical trial study registered on the Drug Clinical Trial Registration and Information Disclosure Platform was selected, and the following data modules were extracted from the structured data of 4 case report forms: demographics, vital signs, local laboratory data, and concomitant medications. The extracted data was mapped and transformed, deidentified, and transferred to the sponsor's environment. Data validation was performed based on availability, completeness, and accuracy. In a secure and controlled data environment, clinical trial data was successfully transferred from a hospital EHR to the sponsor's environment with 100% transcriptional accuracy, but the availability and completeness of the data could be improved. Data availability was low due to some required fields in the EDC system not being available directly in the EHR. Some data is also still in an unstructured or paper-based format. The top-level design of the eSource technology and the construction of hospital electronic data standards should help lay a foundation for a full electronic data flow from EHRs to EDC systems in the future.

Effect of pharmacist care on clinical outcomes and therapy optimization in perioperative settings: A systematic review.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Integration of pharmacists into the perioperative practice has the potential to improve patients' clinical outcomes. The aim of this systematic review is to systematically investigate the evidence on the roles of pharmacists in perioperative settings and the effects of pharmacist interventions on clinical outcomes and therapy optimization. A protocol-led (CRD42023460812) systematic review was conducted using search of PubMed, Embase, CINAHL and Google Scholar databases. Studies that investigated the roles and impact of pharmacist-led interventions in the perioperative settings on clinical outcomes were included. Data were extracted and quality assessed independently by two reviewers using the DEPICT-2 (Descriptive Elements of Pharmacist Intervention Characterization Tool) and the Crowe Critical Appraisal Tool (CCAT), respectively. Studies were grouped according to the clinical area into 5 sections: (1) pain control and opioid consumption; (2) venous thromboembolism (VTE); (3) surgery-related gastrointestinal complications; (4) postoperative medication management; and (5) total parenteral nutritional. Nineteen studies involving a total of 7,168 patients were included; most studies were conducted in gastrointestinal (n = 7) and orthopedics (n = 6) surgical units. Most included studies (n = 14) employed a multicomponent intervention including pharmaceutical care, education, guideline development, drug information services, and recommendations formulation. The processes of developing the implemented interventions and their structures were seldom reported. Positive impacts of pharmacist intervention on clinical outcomes included significant improvement in pain control and reductions in the incidence of VTE, surgery-related stress ulcer, nausea, and vomiting. There is inconsistency in the findings related to medication management (ie, achieving desired therapeutic ranges) and management of chronic conditions (hypertension and type 2 diabetes). Whilst there is some evidence of positive impacts of pharmacist intervention on clinical outcomes and optimizing drug therapy, this evidence is generally of low quality and insufficient volume. While this review suggests that pharmacists have essential roles in improving the care of patients undergoing surgery, more research with rigorous designs is required.

Predicting Drugs Suspected of Causing Adverse Drug Reactions Using Graph Features and Attention Mechanisms.

Adverse drug reactions (ADRs) refer to an unintended harmful reaction that occurs after the administration of a medication for therapeutic purposes, which is unrelated to the intended pharmacological action of the drug. In the United States, ADRs account for 6% of all hospital admissions annually. The cost of ADR-related illnesses in 2016 was estimated at USD 528.4 billion. Increasing the awareness of ADRs is an effective measure to prevent them. Assessing suspected drugs in adverse events helps to enhance the awareness of ADRs. In this study, a suspect drug assisted judgment model (SDAJM) is designed to identify suspected drugs in adverse events. This framework utilizes the graph isomorphism network (GIN) and an attention mechanism to extract features based on patients' demographic information, drug information, and ADR information. By comparing it with other models, the results of various tests show that this model performs well in predicting the suspected drugs in adverse reaction events. ADR signal detection was conducted on a group of cardiovascular system drugs, and case analyses were performed on two classic drugs, Mexiletine and Captopril, as well as on two classic antithyroid drugs. The results indicate that the model can accomplish the task of predicting drug ADRs. Validation using benchmark datasets from ten drug discovery domains shows that the model is applicable to classification tasks on the Tox21 and SIDER datasets. This study applies deep learning methods to construct the SDAJM model for three purposes: (1) identifying drugs suspected to cause adverse drug events (ADEs), (2) predicting the ADRs of drugs, and (3) other drug discovery tasks. The results indicate that this method can offer new directions for research in the field of ADRs.

Trends and off-label utilization of antipsychotics in children and adolescents from 2016 to 2021 in China: a real-world study

BackgroundGlobal antipsychotic usage, including off-label prescriptions, has increased in recent decades. However, trends in China, particularly for children and adolescents, remain unclear. This study explored these trends from 2016 to 2021 and identified factors associated with off-label prescriptions.MethodsIn this retrospective study, we analyzed on-label and off-label prescriptions based on drug information approved by the China National Medical Products Administration. To identify factors associated with off-label prescriptions, we conducted multivariate logistic regression analysis.ResultsOur study included 48,258 antipsychotic prescriptions, 52.4% (25,295) of which were prescriptions for males. Of these, 61.7% (29,813) were off-label. Over time, the number of antipsychotics and the percentage of off-label prescriptions for children and adolescents overall increased from 2016 to 2021. The use of atypical antipsychotics increased, whereas that of typical antipsychotics decreased. For off-label usage, all of the factors in our study were associated with off-label usage, including age, sex, year, region, department, reimbursement, antipsychotic type, drug expense, number of polypharmacy and diagnoses. Additionally, tiapride (15.8%) and aripiprazole (18.6%) were the most common typical and atypical antipsychotics, respectively. For pediatric diseases, common diagnoses included mood or affective disorders (31.7%) and behavioral and emotional disorders, with onset usually occurring in childhood and adolescence (29.1%). Furthermore, a depressive state was the most common diagnosis for which antipsychotic polypharmacy was used for treatment.ConclusionIn this retrospective study, off-label antipsychotic prescriptions were common, with trends generally increasing among children and adolescents from 2016 to 2021. However, there is a lack of evidence supporting off-label usage, thus emphasizing the need for studies on the efficacy and safety of these treatments.