Electrochemically activated peroxymonosulfate with modified TiO2 nanotube array anode for PPCPs degradation and pharmaceutical wastewater detoxification: Mechanistic insights and practical implications.

Asthma control remains suboptimal worldwide, often due to modifiable factors such as incorrect inhaler technique and reliever overuse. Community pharmacists (CPs) are well-positioned to address these gaps through structured patient education. A point prevalence evaluation was conducted in 1247 patients across 127 community pharmacies (11.1% of all pharmacies) in North Macedonia (Dec 2023-Sep 2024). Asthma control was assessed using the Asthma Control Test (ACT), while Asthma Slide Rule (ASR) was used to evaluate short-acting beta-agonists (SABAs) use. Inhaler technique was assessed using device-specific checklists. CPs provided comprehensive care, including adherence support, lifestyle counselling, and monitoring. Poor inhaler technique strongly predicted poor asthma control (ACT: OR = 5.98; ASR: OR = 6.43). Among 127 patients followed, correct technique improved from 71.7% at baseline to 88.8% at the second visit, and among patients who attended all three visits, accuracy increased from ∼63% at the first visit to∼89% at the second and 98.2% at the third (56 patients). By the third visit, the association between technique and control diminished, reflecting the success of comprehensive pharmaceutical care. These results highlight the critical, multifaceted role of CPs in improving asthma outcomes and support the integration of CP-led comprehensive pharmaceutical care for asthma into national management strategies.

ABSTRACTBackground and AimsAntimicrobial resistance (AMR) is a global health crisis, particularly predominant in low‐ and middle‐income countries. Pharmacists play a crucial role in combating AMR, especially through antimicrobial stewardship (AMS) initiatives. In Ghana, the training of pharmacists includes a mandatory 1‐year internship before licensure, aimed at ensuring that graduates are well‐prepared to deliver high‐quality pharmaceutical care. However, the extent to which this training equips interns to address AMR, especially through AMS, remains unclear. This study aimed to determine the knowledge and perceptions of pharmacy interns in Ghana on antimicrobial use (AMU), AMR, and AMS to identify gaps or deficiencies in their training.MethodsA cross‐sectional study was conducted among 195 pharmacy interns who had just sat for the Ghana Pharmacy Professional Qualifying Examination (GPPQE). A questionnaire adapted from previously published studies was used to collect data. Data were analyzed descriptively using Google Sheets. Knowledge scores were categorized using Bloom's cut‐off criteria: a score of ≥ 80% was considered “good,” while < 80% was classified as “moderate to poor.”ResultsMost interns had received training on AMU (92.3%), AMR (90.3%), and AMS (81.5%). Good knowledge levels were observed for AMU (65.6%) and AMR (58.9%); however, only 43.1% demonstrated good AMS knowledge. Despite 92.3% of interns perceiving the quantity and quality of their knowledge to be good, only 58.0% strongly agreed they had received sufficient training, and 64.6% expressed a desire for further education on AMU, AMR, and AMS, reflecting awareness of training gaps.ConclusionAlthough most interns received training, there were critical knowledge gaps present, particularly in AMS. While interns held positive perceptions of their stewardship roles, a gap exists between their self‐assessed knowledge and objective knowledge performance, especially regarding AMS. Reviewing internship training objectives and harmonizing AMS education across training institutions is recommended to ensure that pharmacy graduates are well prepared for their stewardship roles in practice.

Preparing Army pharmacists for the future fight: An Army pharmacy critical care short course for large-scale combat operations.

ObjectiveTo compare clinical outcomes, quality of life (QoL), medication behaviors, and readmission risk between older adults with multimorbidity receiving integrated Internet-based pharmaceutical care and those receiving conventional pharmaceutical care.MethodsThis prospective observational study enrolled 196 older adults with multimorbidity who received either conventional or integrated Internet-based pharmaceutical care according to the service model in routine practice. After 6 months, BG and BP control rates, hospitalization rates, and patient satisfaction were compared. Frailty, health-related quality of life, medication self-management, and adherence were assessed using the FRAIL scale, EQ-5D/EQ-VAS, SEAMS, and ARMS-12, respectively. Logistic regression was used to examine the association between care model and 12-month readmission.ResultsAt the 6-month follow-up, the integrated Internet-based pharmaceutical care group had significantly higher BG and BP control rates and patient satisfaction than the conventional care group (P < 0.05). The integrated Internet-based care group also had lower FRAIL scores and higher EQ-5D and EQ-VAS scores. SEAMS scores were significantly higher, and ARMS scores were significantly lower in the Internet-based care group (P < 0.001). The integrated Internet-based pharmaceutical care model was significantly associated with a lower risk of 12-month readmission (OR = 0.424, 95% CI: 0.203–0.884, P = 0.022).ConclusionIntegrated Internet-based pharmaceutical care was associated with favorable medication-related and clinical outcomes in older adults with multimorbidity. Further studies are needed to confirm these findings and clarify their generalizability.

Chronic Obstructive Pulmonary Disease (COPD) is a major health concern in low and middle-income countries. Drug-related problems (DRPs), defined as issues in drug therapy that interfere with desired outcomes, add further challenges. Evidence on the prevalence and costs burden of DRPs in COPD patients is limited. This study assessed the prevalence of DRPs, identified associated factors, and compared prescription costs between patients with and without DRPs. A cross-sectional study was conducted among 156 COPD patients attending a first referral hospital in Dailekh, Nepal, from May to September 2024. Data were collected through in-person interviews using a structured questionnaire and medical record review. DRPs were classified using the Pharmaceutical Care Network 9.1 system. Prevalence and medications costs were reported. Factors associated with DRPs were analyzed using bivariate tests and multivariate logistic regression. Medication costs were calculated using hospital pharmacy prices and mean costs with 95% confidence interval were compared across groups. The prevalence of DRPs was 71.8%, with patients experiencing an average of 1.45 DRPs. Male patients (AOR 3.0; 95% CI 1.2-7.4), those from disadvantaged ethnic group (AOR 3.3; 95% CI 1.1-9.8), and patients with comorbidity (AOR 2.7; 95% CI 1.2-5.9) were more likely to have DRPs. The mean cost per patient was NRs. 6543 ± 1423.4). DRPs are highly prevalent among COPD patients and contribute to significant financial burden. Strengthening the role of pharmacists and other health professionals in identifying and preventing DRPs is essential. Targeted interventions for high-risk groups can help reduce DRPs, improve treatment outcomes, and lessen the economic impact on patients.

Pharmacists in Chinese public hospitals face multiple challenges, including a rapidly increasing workload and a severe human resource shortage, driven by the continuous advancement of healthcare reform. This study systematically investigated the content and responsibilities of hospital pharmacy work as well as the current state of workload and human resource allocation in pharmacy departments, and then analyzed the challenges and optimization strategies. A work list of pharmacy departments in public hospitals was developed for the investigation and then a structured questionnaire was designed based on the work list. A survey was conducted to collect and analyze the data on various duties within the pharmacy departments of 22 representative tertiary and secondary public hospitals covering all 7 regions of China. A work list for pharmacy departments in public hospitals was compiled. The proportion of pharmacists accounted for only 3.60% of all health technicians in the surveyed public hospitals. Significant disparities in human resource allocation were found between tertiary and secondary hospitals, with their current staffing levels meeting only 40.16% and 25.26% of the actual demand, respectively. Pharmacy departments in public hospitals generally face workload overload, severe human resource shortages, and structural imbalances in personnel, which in turn severely limit the application of pharmacists' professional knowledge and hinder the quality improvement of clinical pharmacy services, ultimately restricting the patient-centered transition of pharmaceutical care. Therefore, it is urgently recommended to refine the corresponding mechanisms for pharmaceutical human resource allocation and value compensation.

ABSTRACT Pharmaceutical and personal care products (PPCPs) and heavy metals are recognised as emerging contaminants due to their persistence, potential for bioaccumulation, and associated ecological risks. This study evaluated their occurrence in water, sediment, and Rhamdia wagneri from the Cauca River (La Virginia, Colombia), a tropical river system under strong anthropogenic pressure. Seven PPCPs were detected in fish, five in water, and four in sediment. Ibuprofen reached the highest concentration in water (386.6 µg L−¹), while galaxolide (2900 µg kg−¹) and bisphenol A (800 µg kg−¹) were predominant in fish tissues, indicating potential bioaccumulation in edible species. Statistical analyses confirmed significant differences among matrices, with fish being the most affected compartment. Heavy metals displayed a contrasting pattern: arsenic was detected in water (2.94 mg L−¹), zinc and copper in sediment (10.69 and 4.89 mg kg−¹, respectively), and all metals were below detection limits in fish, suggesting limited bioavailability. These findings contribute baseline information on emerging contaminants in Colombian rivers and underscore the need for continuous monitoring, improved wastewater treatment, and the incorporation of PPCPs into water-quality management and regulation frameworks. Highlights This work provides foundational baseline data on PPCPs and heavy metals in the Cauca River, one of Colombia’s most important tributaries. Rhamdia wagneri exhibited the highest PPCP burdens, indicating their potential for bioaccumulation and raising concerns regarding human exposure through fish consumption. Findings underscore the need for strengthened wastewater treatment, regulation of PPCPs, and long-term monitoring programmes to protect aquatic ecosystems and public health in Colombia.

Pharmaceutical Care (PC) has emerged as a vital component of the healthcare system, involving the provision of medication therapy to achieve specific outcomes that enhance a patient's quality of life. Therefore, this study aims to evaluate PharmD interns' self-reported attitudes, perceptions of the skills required to provide PC using multiple domains (technical, psychosocial, communication, and administrative aspects) and perceived barriers to implementing PC, and recommendations. A cross-sectional study was conducted between May and December 2023, utilizing pretested questionnaires with PharmD interns at Saudi universities in Riyadh, Saudi Arabia. The questionnaire included sociodemographic information, attitudes (13 items), perceptions (24 items), importance (19 items), barriers (17 items) toward PC, and recommendations (4 items). To find out the association between variables chi-square, Analysis of Variance, and Spearman correlation were used to examine differences in perceptions and correlations between attitude and perception scores, with a P value < .05 considered statistically significant. A total of 216 PharmD interns participated, with 59.7% being male, 94.9% Saudi nationals, and a mean age of 24.08 ± 0.98 years. The majority (72.7%) were 24 years old. Participants were from public (57.9%) and private (42.1%) universities in Riyadh. The mean attitude score towards PC was 51.25 ± 9.38, and the mean perception score was 106.67 ± 16.01. Attitude scores were significantly associated with gender and university type (P < .001), while perception scores showed significant associations with gender, age, and university type (P < .01). The results of the Spearman correlation analysis indicated a moderate, statistically significant positive correlation between mean attitude and mean perception scores (R = 0.345, P < .01). Most interns agreed that pharmacists should prevent and solve medication-related problems (86.6%) and provide PC (85.7%). However, 43.5% believed that PC is not worth the additional workload. The most frequently reported barriers were lack of financial compensation (65.8%), inadequate staffing (62.5%), limited private counseling areas (60.7%). Most of the PharmD interns have a positive attitude towards PC but face structural and educational barriers to PC implementation. Future research should focus on overcoming these barriers and promoting Interprofessional healthcare courses to enhance patient outcomes.

Public perceptions of community pharmacists' evolving role in health promotion and pharmaceutical care: A cross-sectional study in Indonesia.

Children in foster care (FC) experience disproportionately high rates of mental health (MH) needs and frequently use behavioral health services. They are overrepresented in restrictive MH settings and are more likely to be prescribed psychotropic medications. Home-based behavioral health services (HBHS) offer a less restrictive alternative for addressing the complex needs of children in FC, but their use and effectiveness remain understudied. Using Medicaid data from 28 states, we examined MH service utilization among children aged 3-18 with primary MH diagnoses across three eligibility groups: FC (n=128,180), disability (n=214,959), and low-income (n=1,054,426). We summarized utilization patterns, estimated multivariable models of HBHS take-up, and assessed associations between HBHS and other MH-related care. About 60% of children in FC had a MH diagnosis, compared with 65% of children with disabilities and 19% of children with income-based eligibility. HBHS use was highest among children in FC (29%), exceeding use among children with disabilities (15%) and low-income children (10%). Among children in FC, HBHS use was associated with greater MH diagnostic complexity, Black and Hispanic race/ethnicity, and certain MH diagnoses. HBHS use (vs. no use) was associated with lower odds of hospitalization (aOR=0.82), ED visits (aOR=0.75), and new psychotropic prescriptions (antipsychotics aOR=0.76; SSRIs aOR=0.80; ADHD medications aOR=0.77), and higher odds of school-based MH service use (aOR=1.47). HBHS are widely used within FC and serve clinically complex populations. Their use was linked to reduced reliance on restrictive and pharmaceutical care, suggesting that expanding access may enhance MH services for children.

To describe the status of home medication behaviors and medication literacy among older patients with chronic diseases in China and to identify factors influencing medication literacy levels to inform improvement strategies. A national cross-sectional study was conducted from October 2022 to the end of June 2023 across 31 provinces using a multi-center, quota-based convenience sampling approach. Trained pharmacists collected data via face-to-face interviews using a validated Knowledge, Attitude, and Practice (KAP) questionnaire. Medication literacy was dichotomized into adequate (score ≥186) and inadequate (<186). Multivariable logistic regression was employed to identify associated determinants. Among the 10,363 eligible participants, 48.31% demonstrated adequate medication literacy. Prevalent suboptimal home medication behaviors were observed: 57.05% failed to completely retain original medication packaging, and 74.25% could not fully understand package inserts. Through multivariable logistic regression, several key factors were identified as significant predictors of medication literacy. Higher educational attainment (college degree and above: OR = 2.185, 95% CI: 1.744 to 2.738) was identified as a strong predictor of adequate literacy. Conversely, discarding medication package inserts (OR = 0.697, 95% CI: 0.588 to 0.828) and the inability to comprehend package inserts (OR = 0.265, 95% CI: 0.226 to 0.311) were found to be negatively associated with literacy levels. Furthermore, 93.60% of the cohort reported the presence of somatic symptoms, which were frequently misattributed to normal aging rather than potentially modifiable medication-related causes. Medication literacy among older Chinese adults with chronic diseases remains suboptimal, with nearly half failing to achieve adequate levels. Independent self-management is significantly associated with socioeconomic factors and specific behavioral gaps. A home-based pharmaceutical care system should be implemented to prioritize vulnerable groups, advocate for the retention of original packaging, and promote the development of simplified medication instructions.

Community pharmacies play a vital role in delivering primary healthcare services, particularly in developing countries where accessibility and affordability are critical. In recent years, the concept of service quality has gained increasing attention as a determinant of customer satisfaction and loyalty. This study evaluates the dimensions of service quality in community pharmacy practice and examines their influence on customer loyalty. The research adopts a conceptual and analytical approach by integrating established service quality frameworks with pharmaceutical care practices. Key dimensions such as accessibility, pharmacist competence, interpersonal behavior, drug availability, counseling effectiveness, and pricing transparency are analyzed. The study finds that relational aspects of service delivery, especially pharmacist–patient interaction and counseling, have a stronger impact on customer loyalty compared to structural factors. The findings highlight the need for community pharmacies to adopt patient-centered service models to enhance long-term customer relationships and healthcare outcomes. Community pharmacies play a vital role in delivering primary healthcare services. This study evaluates service quality dimensions and their influence on customer loyalty. Findings indicate that pharmacist behavior and counseling significantly impact loyalty.

Inhaled corticosteroid (ICS) overuse is common in chronic obstructive pulmonary disease (COPD) and associated with substantial adverse effects. Deprescribing has emerged as a strategy to optimize therapy, yet large-scale evidence on the prevalence and associated factors of eligibility for ICS deprescribing is limited. This nationwide cross-sectional study analyzed data from the Cough and Wheeze Pharmaceutical Care Clinics database between January 2021 and September 2024. Patients aged ≥40 years with physician-diagnosed COPD receiving long-acting inhaled therapies were included. We examined treatment patterns, estimated ICS use, and assessed eligibility for deprescribing using European Respiratory Society (ERS), American Thoracic Society (ATS), and Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2026 criteria, applied respectively to any ICS-containing regimens, triple therapy, and ICS/long-acting beta-agonist (LABA) combinations. Factors associated with ICS deprescribing eligibility were identified using multivariable logistic regression, with sensitivity analyses on complete-case data. Of 33,243 patients, 24,886 (74.9%) received ICS-containing regimens, mainly triple therapy and ICS/LABA. Among them, 79.5% met ERS criteria for deprescribing. In the triple therapy subgroup (n = 12,388), 68.9% met ATS criteria, while 74.0% of patients on ICS/LABA combinations (n = 12,340) met GOLD criteria. Eligibility was positively associated with male sex, older age, higher regional economic level, lack of health insurance, and care in secondary hospitals, whereas higher comorbidity burden was negatively associated. Sensitivity analyses yielded consistent results. These findings highlight that ICS overuse is common among COPD patients in China, with most being eligible for deprescribing. Implementing targeted strategies that address the identified associated factors could support deprescribing and enhance treatment optimization.

The use of gastric acid suppressants such as Proton Pump Inhibitors (PPI) and Histamine-2 Receptor Antagonists (H2RA) is very common in inpatient settings, but inappropriate use is often found, posing risks to patient safety and cost efficiency. This study aims to analyze the relationship of predictors (age, number of drugs, number of comorbidities, and length of stay) to the occurrence of Drug-Related Problems (DRPs) in inpatients using gastric acid suppressants. This study was an observational study with a cross-sectional design was conducted retrospectively using patient medical record data at Rumkital Dr. Mintohardjo from January to December 2024. A sample of 432 patients was taken using a simple random sampling technique based on inclusion criteria. DRPs were identified using the Pharmaceutical Care Network Europe (PCNE) V9.00 instrument. Data analysis used the chi-square test for bivariate analysis and binary logistic regression for multivariate analysis. DRP characteristics were dominated by treatment safety issues (70.4%), particularly adverse drug events, with the most frequent drug interaction being ranitidine and ketorolac. Bivariate analysis showed that comorbidities (p=0.029), length of stay (p=0.010), and number of drugs (p=0.000) significantly influenced the number of DRPs. Multivariate analysis identified the number of drugs as the most influential predictor; inpatients receiving ≥10 drugs had a 2.733 times higher risk of experiencing ≥2 DRPs (p=0.000; OR 2,733; 95% CI 1.767-4.229)

The status, barriers and associated facilitators of pharmaceutical care provision in public tertiary healthcare settings: a cross-sectional perspective from a low-middle-income country.

Adolescents with complex chronic conditions have substantial healthcare needs during the transition from pediatric to adult care, but out-of-hospital service use and costs are not well quantified. In this prospective cohort study, adolescents attending the Transition Support Service clinic at the Royal Children's Hospital Melbourne were recruited. Linked Medicare data (2016-2021) were available for 161 participants, capturing 20,142 medical and 11,087 pharmaceutical records. Out-of-hospital service utilization and costs were analyzed annually before and after transition to adult care using MBS and PBS data, with descriptive analyses and interrupted time-series models. Mean annual general practitioner visits increased from 4.7 pre-transfer to 6.3 in the year before transfer and stabilized thereafter. Specialist consultations remained high post-transfer, peaking at 4.5 visits per year. Annual pharmaceutical costs increased from A$1757 pre-transfer to A$7027 post-transfer. Nervous system medicines account for 20% of prescriptions throughout. Overall costs increased over time, with pharmaceuticals comprising 50% of total costs pre-transfer and approximately 90% post-transfer. Adolescents with complex chronic conditions experience persistently high and increasing use of out-of-hospital care across the transition to adult care. Increases in utilization and costs begin prior to transfer and remain high throughout the transition period. This study provides robust evidence on patterns of out-of-hospital medical and pharmaceutical care use and expenditure pre and post transfer to adult care, using linked administrative Medicare data. Primary care use increased in the years preceding transfer and remained high following transition, indicating sustained reliance on primary care across the transition period. The rising use of specialist care, pathology, and diagnostic services, together with rising pharmaceutical expenditure, particularly for therapies accessed in adult care, highlights the clinical complexity for adolescents with chronic conditions during this critical period.

Overview of clinical pharmacy activities in geriatric oncology: A systematic review.

This case describes the individualised pharmacological management of a 2-month-old infant with genetically confirmed type I hypertriglyceridemia due to lipoprotein lipase (LPL) deficiency. After the failure of conventional treatment and contraindication to plasmapheresis, intravenous insulin therapy was initiated, followed by subcutaneous insulin and omega-3 fatty acid adjustment. The hospital pharmacist played a key role in selecting off-label treatments, adapting pharmaceutical forms for paediatric use and performing therapeutic reconciliation. The approach was effective and safe, achieving triglyceride levels below 1000 mg/dL and clinical stability. This report contributes practical evidence on alternative treatment strategies for a rare disease with limited therapeutic options in paediatrics, highlighting the importance of a multidisciplinary approach and pharmaceutical care.

IntroductionAntineoplastic chemotherapy (ACT) is widely used, but involves significant risks due to protocol complexity and inherent toxicity. Pharmacists play a key role in validating ACT prescriptions to enhance patient safety.ObjectiveTo analyze medication errors during ACT prescribing and describe pharmaceutical interventions performed to manage these errors at a Federal University Hospital in the Central-West region of Brazil.MethodologyThis cross-sectional study, supplemented with case reports, was conducted between January 2023 and July 2024. A total of 382 prescriptions for 208 oncology outpatients were analyzed; only prescriptions with previously identified medication errors were included in this study. Medication errors were classified as decision-making or writing errors according to the Pharmaceutical Care Network Europe (PCNE) classification and Dean et al. (2000), and categorized by severity using the NCC MERP framework. Data were extracted from an institutional database and validated by an oncology specialist pharmacist. Only deviations with potential pharmacological or clinical impact were classified as decision-making errors, excluding minor operational adjustments.ResultsDecision-making errors occurred in 91.6% (n = 358/391) of prescriptions, primarily due to inappropriate diluent volumes (91%), while writing errors were observed in 8.4% (n = 36/391), mainly from missing clinical information. Pharmaceutical interventions were accepted in 99% of cases, preventing errors from reaching patients. Most errors were intercepted before administration (NCC MERP Category B), though two cases had potential clinical consequences (Category C) and one required patient monitoring due to communication issues (Category D).ConclusionSpecialized oncology pharmacists play a critical role in ensuring the safety of ACT prescribing. The high proportion of decision-making errors observed within this selected sample emphasizes the need for systemic improvements, such as integrated electronic prescribing and continuous pharmacist-led oversight, to reduce preventable errors and enhance patient safety.