Pharmacy Research Research Articles

Service evaluation of the research outputs for 23/24 at a large London teaching hospital

Abstract Introduction The recent report of a UK survey of pharmacy professionals’ involvement in research1 found only small numbers of the pharmacy workforce are currently undertaking research. A number of reasons for this are identified and the report contains a list of recommendations to support the embedding of research into pharmacy careers.1 Within the pharmacy department at King’s College Hospital NHS Foundation Trust (KCH) all research proposals are presented at the pharmacy research and audit group and a log is kept of department research outputs by the clinical academic research lead. The analysis of this data will provide a benchmark. For the purposes of this study, research encompasses audit, service evaluation and research studies as defined by the Health Research Authority defining research table.2 Aim To identify, over the financial year 23/24, the frequency of different types of research outputs from the pharmacy department at KCH broken down by output type, specialty and role. Methods Regular emails were sent April 23 – March 24 to remind staff to identify and share research outputs with the clinical academic research lead. Outputs received were circulated by newsletter to encourage and motivate others. The clinical academic research lead engaged with individual pharmacy teams throughout the year to encourage and support research outputs. Research output data was collected, April 23 – March 24, on an Excel spreadsheet including staff name, role, specialty, type of research output and date the output was completed. Research outputs were categorised into published articles, published abstracts, attendance at conference, abstracts presented at conference and presentations at conference or national webinar. Ethics was not required as the study is defined as a service evaluation. Results There were a total of 89 research outputs by the pharmacy department across the year. These were broken down into published articles (20), published abstracts (16), attendance at conference (24), abstracts presented at conference (26) and presentations at conference or national webinar (3). The two specialty teams who produced or took part in the most research outputs over the year were critical care (15) and liver (11). Consultants pharmacists were involved in the most research activity (32) followed closely by principal pharmacists (26), specialist pharmacists (25) and the deputy chief pharmacists (19). Pharmacy technicians, pharmacists taking part in the STEP programme and non-registered pharmacy staff scored the least in terms of research activity relative to size of staff group. Consultant pharmacists and principle pharmacists were the groups that published the most articles (8 each). Discussion and conclusion The trust implemented a new electronic patient record system during the year which may have impacted the number of research outputs. A limitation to this study is that there are likely to be unrecorded research outputs. The data broken down by specialty and role will allow the pharmacy management group and clinical academic research lead to support, engage and motivate in those areas to allow staff to have the time, skills and guidance to carry out research activities. The results can be used by other healthcare organisations to benchmark against.

Development of a pharmacy research career pathway discussion tool

Abstract Introduction Research is one of the four pillars of the RPS curriculum and forms Domain 5 of the credentialing pathway. However, gaining and using these research skills in the workplace appears challenging with low self-reported research confidence identified1, lowest domain pass rates in RPS Credentialing reports2 and a minority of the workforce identified as research active3. In order to support Welsh practitioners, Pharmacy Research Wales (PRW) has developed a tool to aid research discussions and awareness, identifying National research opportunities and potential career pathways, with relevant practice and portfolio evidence. Aims Develop a pharmacy research career pathway discussion tool to support career planning and evidence for the RPS credentialing portfolio. Method A literature search and review of RPS, National and local guidelines informed the tool drafting. A Microsoft form “tool” questionnaire was developed (PRW working group) and disseminated by email to a pharmacist cohort (n=10) established by Health Education Improvement Wales to support consultant credentialing. Subsequently members were invited to an in-person one-hour stakeholder development group (n=7) to discuss the tool and agree any modifications. A support moderator took anonymised notes which were reviewed for accuracy, with stakeholder clarification where necessary. No ethics approval was required as no patient involvement and data were anonymised. Questions explored usefulness, self-explanation, pathway self-recognition and improvements. A second draft was presented at 2023 RPS Wales conference research workshop for feedback. Results A schema was drafted describing timelines from foundation to consultant together with relevant examples of research opportunities and suggested portfolio evidence. All survey responses (7/10) indicated usefulness of tool: “good visual guide; draws everything together for the research domain” with 6/7 recognising this pathway as part of their own journey. Respondents (4/7) indicated it was not “self-explanatory”, suggesting removal of abbreviations, an introduction or a step-by-step guide but were positive for use as a mentor/mentee discussion tool. At the RPS research workshop tables (n=6) of ~7 delegates discussed and were asked to self-identify their research progression. Delegates annotated the tool (n=12) with 3, 8, and 1 respectively reporting foundation, advanced and consultant levels. Discussion and conclusion A research tool has been developed to support discussions relating to research career pathway planning and execution. Although there are methodological limitations to this work, for example sample size, it has been well received by the workforce with feedback highlighting areas such as increased awareness of research opportunities, a clear overview of research pathway examples and time investments required, supporting the need for advanced planning. Although aimed at Welsh practitioners, the template is generic and could be extrapolated to the UK workforce. The schema exemplars uni-professional and multi-disciplinary team pathways, the latter relying on research active medical staff. A high percentage of currently credentialled consultant pharmacists described using this latter route, confirming the need to build our own clinical academic workforce and support NHSE survey2 recommendations. Further work is required to embed this tool within the workforce and leadership bodies, facilitating research career pathway awareness, discussions and growth both within and across organisations.

Exploring patients’ views and experiences of side-effects and how they are reported, a focus group study

Abstract Introduction Adverse drug reactions (ADRs) are an increasing health concern, causing considerable physical, psychological and economic impacts1,2. The yellow card scheme (YCS) is the UK’s spontaneous reporting system, allowing patients and healthcare professionals to report ADRs (3). Research has shown that patient reports could provide a beneficial insight into real-world situations and are a key aspect of pharmacovigilance2. Despite this, under-reporting by patients remains a significant issue that needs to be addressed1. Aim This study aimed to explore views and experiences of the public regarding ADR reporting. Methods Following approval from Cardiff University School of Pharmacy and Pharmaceutical Sciences Research Ethics Committee, adult members of the South Wales public who had experienced an ADR (“side-effect”) were invited via social media outlets such as Facebook and WhatsApp to participate in an online (Zoom) focus group to discuss their ADR experience (including whether they reported) and knowledge and views on the YCS. Healthcare professionals were excluded from the study. Written informed consent and demographic information via a short online survey were obtained prior to the focus group. The focus groups were audio and video recorded via Zoom and discussions were transcribed verbatim. A thematic analysis was executed to identify fundamental themes. Results Four focus groups, involving 11 participants took place. The sample consisted mostly of females between 18-30 years of age from an ethnic minority background. Themes identified were lack of knowledge of ADRs and the YCS; support and barriers to reporting ADRs and strategies for improving YCS reporting. There was a lack of knowledge of ADRs with uncertainty over the concept of “side-effect” and varying degrees of understanding on the topic. All participants had suffered side-effects that were severe in nature, affecting them physically, psychologically or cosmetically. None of the participants had any concept of the YCS and side-effect reporting. Despite this, participants felt reporting of side-effects was vital to ensure the safety of medications and prevention of patient harm. The majority of participants sought support for side-effects from a General Practitioner (GP) or community pharmacist, although difficulties accessing GP appointments was a barrier. Strategies suggested for increasing awareness of YCS to increase ADR reporting were use of posters, social media, QR codes, online prompts, coffee mornings and letters sent home to parents from schools. Discussion / Conclusion If patients are unsure around the concept of a side-effect and don’t know about the YCS, reporting rates will continue to fall. Although it is recognised that the sample is not fully representative of the Welsh population, this small-scale exploratory study has nevertheless identified some possible concerns but also some opportunities to engage patients in ADR reporting. Patient education by healthcare professionals on side-effects, alongside increased promotion of the YCS via social media and advertisements in healthcare settings are key opportunities to increase patients’ awareness and understanding of ADRs and ADR reporting. Further research is essential to understand the extent of these issues and also to investigate how healthcare professionals can facilitate this process. Follow-up studies are planned.

How do people use community pharmacies to manage sleep problems? A cross-sectional survey of pharmacy customers in England, UK

Abstract Introduction Insomnia and sleep problems have become increasingly common in the UK population, with research indicating a rise in the prevalence of sleep issues and the use of hypnotic medications1. Poor sleep can severely affect overall health and has been linked to cardiovascular disease, type 2 diabetes, and other conditions2. Community pharmacies are ideally positioned to advise people about sleep, but there is limited information about how people currently utilise them for sleep problems. Aim To understand how people use community pharmacies to manage problems with sleep Methods A researcher-administered questionnaire with customers at 16 community pharmacies in the East Midlands from the 6th to 25th of March 2023. People aged 18 and older were approached to take part. Survey questions included demographic information, general pharmacy use, and specific questions related to health-seeking advice for sleep problems. Responses were recorded using the Qualtrics survey platform and descriptive statistics derived using MS Excel. Ethical approval was given by the School of Pharmacy Research Ethics Committee at the University of Nottingham (2017-017er). Results 13,127 customers were approached to take part, and 4,985 consented and completed the questionnaire (response rate = 38.0%). Two thirds of participants were female (66.3%), half were above the age of 50 years (51.1%), and the majority identified as white ethnicity (79.8%). Just under one-third of participants reported purchasing a medicine, herbal remedy, or other product to help with sleep in the past (28.2%), of which 81.8% had purchased from a community pharmacy. The most common medicines purchased were anti-histamines (43.7%), followed by herbal remedies (34.1%). Only 19.1% of participants had previously sought advice for a sleep problem, of which 64.9% had sought advice from a GP/other healthcare professional, and 29.2% had sought advice from a community pharmacy. The most common advice received from a community pharmacy was to use a medicine (32.2%), with the second most common being sleep hygiene/lifestyle advice (22.8%). The most common advice received from a GP was also to use a medicine (36.4%). Discussion / Conclusion A significant proportion of survey participants reported purchasing a medicine, herbal remedy, or other product to help with sleep from a community pharmacy, highlighting the significant role of pharmacies in managing sleep issues. However, considerably fewer customers had sought advice for their sleep problem, identifying a potential gap in care. Current national guidelines do not recommend medication as first-line treatment for insomnia, emphasising sleep hygiene and behavioural therapy, with no role for sedative anti-histamines3. Despite this, our survey indicated the most common advice focused on medicines. This suggests an opportunity for enhancing the education of healthcare professionals and improving public awareness of managing sleep problems. Whilst this survey involved a large number of participants, we recognise it may not be fully representative of the wider UK population or practice. Further analysis of this survey and interviews with customers and pharmacists would help understand how the role of community pharmacies in managing sleep could be further developed to improve care.

A scoping review of the integration of non-medical prescribing for acute common clinical conditions by community pharmacists

Abstract Introduction Non-medical prescribing enhances patient care, safety, and medication accessibility, while also maximising expertise1. Some evidence exists for a variety of factors at individual, organisational, regulatory, and policy levels impacting the implementation of PP in community pharmacy2. Common clinical conditions (CCC) can be defined as ‘a broad range of self-limiting conditions that are more complex in their diagnosis and treatment than minor ailments and management that often involves the need for prescription medicines’. Aim To collate and characterise literature on the integration of non-medical prescribing for acute common clinical conditions by community pharmacists. Method This scoping review followed the Arksey and O’Malley framework. The review team comprised a doctoral student (LK), a research fellow (TJ) and a professor of pharmacy (SC), all with experience of review methodology, community pharmacy research and /or practice. Eligibility criteria, search databases and terms were defined. Medline, International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature and Google Scholar were searched for full text, English language, peer reviewed original papers, randomised controlled trials, cross-sectional and cohort studies, papers reporting empirical data from primary research and review articles including systematic reviews /scoping reviews /narrative reviews from January 2006 to October 2023. The (global) focus was on services delivered by pharmacists and pharmacy team members in community pharmacy for the management of CCC, using non-medical prescribing rights. Search terms included “independent prescrib*”, “pharm* independent prescri*”, “pharm* prescrib*”, “non-medical prescri*, “non-medical prescri*”, “pharm* supplementary prescri*” and “collaborative prescrib*”. Following screening and full text review a narrative synthesis approach3 was used to address the aim which involved: preliminary synthesis through data extraction and tabulation of key study characteristics, exploration of relationships and differences across the studies and finally evaluation of the robustness of the synthesis. The Consolidated Framework for Implementation Research provided a theoretical lens to support synthesis, identifying barriers and facilitators for integration. All steps were independently checked by two review team members. Ethics approval was not required because this was a scoping review. Results From a total 1018 records identified, 10 papers remained after removal of duplicates, title /abstract screening and full text review. The majority of studies were from Canada and the aims and linked outcomes of studies focused on pharmacists’ views and experiences, evaluation of safety, effectiveness, and patient satisfaction. A range of CCCs were included with a focus on antibiotic prescribing. A wide range of barriers and facilitators to implementation were identified including “regulatory constraints” and “fiscal challenges” at a macro socio-organisational level and a plethora of dichotomous challenges within organisations including a lack of clarity on the pharmacist’s scope of practice and linked consumer confusion, staffing levels and workload, with specific mention of paperwork and access to patient records. Conclusion The small number of studies included indicates that there is a paucity of research in this area. There is a need for increased efforts to consider this topic further and identify ways to address the challenges for further widespread implementation and uptake of such services.

Quantitative evaluation of clinical pharmacy activities following implementation of an enhanced weekend service at a teaching hospital

Abstract Introduction Improving equity of staffing across seven-days is a strategic priority for the National Health Service (NHS).1 Development of enhanced weekend clinical pharmacy services presents opportunity to improve admission and discharge medicines reconciliation (MR), reduce medication error and increase patient counselling.2 At the study site, an enhanced weekend clinical pharmacy service was implemented in October 2021. The service was delivered 9am-5pm to all clinical specialities across 54 wards. Defined minimum staffing was 13 pharmacists and 2 medicines management pharmacy technicians (MMPT). Service specification included: clinical screen and order of medications; admission MR, review of high-risk patients (critical care patients and those prioritised by the weekday team); and discharge activities including patient counselling. Aim To evaluate provision of the enhanced weekend clinical pharmacy service post-implementation by quantification of shift fill and clinical pharmacy professional activities. Methods A quantitative study was conducted over two separate weekends one month and six months post-implementation (13th-14th November 2021 and 9-10th April 2022). Pharmacy professionals collected data using a paper activity tool validated for use at the study site. Interventions included rectification of medication error, medicines optimisation or consult. Data were collated in Microsoft Excel immediately after each study weekend. Simple descriptive statistics were performed in Microsoft Excel. The study was registered with KCH Pharmacy Research and Audit Group (07/2021), deemed service evaluation and ethics approval waived. Results Pharmacy professionals reviewed 1,056 patients over 3,645 occupied bed-days. Services were delivered by 13 pharmacists and 1 MMPT on weekend 1, 12 pharmacists and 1 MMPT on weekend 2. Data were collected for all wards on weekend 1; on weekend 2 activity data was not collected for five surgical wards (Saturday and Sunday), four post-acute medical wards (Saturday) and the acute medical unit (Sunday). Admission MR was conducted for 77% (317/412) of newly-admitted patients. Pharmacists recommended prescription amendment for 68% (217/317) of patients receiving admissions MR; affecting 517 medicines. The recorded intervention rate per patient reviewed was 0.64 (680/1056). Pharmacy professionals responded to 211 queries from healthcare professionals (HCPs), undertook 90 incidences of pro-active HCP education and counselled 92 patients/carers. Pharmacists prepared discharge medication lists or clinically screened discharge prescriptions for 205 patients. A total of 952 non-stock medicines were ordered and 313 patients own medicines checked for suitability for reuse. Discussion / Conclusion These findings add to existing evidence for seven-day clinical pharmacy services. Defined minimum staffing was not fulfilled with 90% shift fill rate. Clear benefit was demonstrated in terms of admission MR and resultant intervention, HCP education, discharge and counselling activities. The percentage of patients with a recommended prescription amendment following admission MR matched findings from a separate service evaluation during February 2021 of an enhanced weekend service introduced at our study site during the COVID-19 pandemic (68%).3 The intervention rate for reviewed patients was also comparable (0.64 compared with 0.57 during COVID-19).3 Limitations include the relatively short period of data collection at a single-site which limits generalisability of findings. There were some gaps in data collection and acceptance rate of interventions was not collected.

The Missing Voices, an exploration of what healthcare-related research would matter to Global Ethnic Majority Women in Aberdeenshire, Scotland

Abstract Introduction In multicultural communities, such as the UK, published evidence has indicated that patients from marginalised backgrounds experience healthcare inequality and inequity with regards to accessibility and safety.1 The lack of appropriate ethnic representation in healthcare-related research, has been identified as a potential causation of some of these disparities and poorer health outcomes.2,3 The focus of this project was the marginalised communities identified by the NIHR to have poorer health outcomes, such as Global Ethnic Majority (GEM) women. Aim To explore what healthcare research matters to marginalised communities with a focus on lived and perceived experiences on access to healthcare for GEM women in Aberdeen city and Aberdeenshire, Scotland. Methods This pilot project captured real world data through an inclusive community engagement approach of reaching within rather than reaching out. A framework of 5Cs (Connect, Collaborate, Consult, Co-create and Circulate) was used to establish a diverse panel of ten GEM women. All panel members had a passion for equality and wellbeing as well as diverse lived experiences. The method used to establish the panel is presented elsewhere. Based on a review of literature, open-ended, flexible, thought-provoking questions for the discussions were developed and circulated to all panel members for approval. These questions were used to guide both in-person and virtual open discussions with aforementioned stakeholders to capture narratives and perspectives around barriers and facilitators to equitable healthcare access in the area. As the public members were research partners and not participants, no ethical approval was required as advised by a professor of pharmacy research and the school’s ethics convenor. The project had three main objectives. This submission will only report on objective three that aimed to Identify and prioritise research questions relating to equitable access to healthcare and the needs of marginalised minority ethnic communities. Results The objective was met. A list of emergent themes from the pre-panel questions and a list of panel-approved research questions were devised with a focus on access to healthcare. The emergent themes were around accessibility and equity of maternal/reproductive healthcare, lack of early screening for high-risk GEM groups and culturally appropriate approaches to mental healthcare. Solution focused recommendations included the design of an inclusive healthcare curriculum, compulsory EDI and cultural competency training for healthcare professionals who practice in diverse communities, additional screening programmes tailored to specific GEM groups based on prevalence and risk factors and the development of localised culturally appropriate and inclusive community programmes, especially for those who support new immigrants. Mistrust and lack of inclusive language were mentioned as potential barriers to participating in research. Discussion / Conclusion This pilot offered the historically under-represented and usually silent communities an equal voice within a trusting and collaborative environment. Over ten years after the enaction of the UK Equality Act (2010) inequity in healthcare access and poor outcomes are still evident. The outcomes of this small pilot study highlight that GEM-specific projects should be driven by that community.

Experiences of treating problematic over the counter and prescription only medication use in substance misuse services

Abstract Introduction There are growing concerns about the misuse of over the counter (OTC) and prescription only medication (POM), due to the associated negative socioeconomic and health implications1. To improve care delivery, stigma needs to be addressed and more needs to be known about the perspectives of staff who are working in substance misuse services (SMS)2. Aims To use confidential semi-structured interviews, to explore the experiences of community English SMS staff who have supported adults that have misused OTC/POM. Methods This research was conducted across five community adult English SMS operated by a national treatment provider. Individuals were eligible for participating in semi-structured interviews if they had current experience of working in a community SMS role which involved supporting adults who had misused OTC/POM, were at least 18 years of age and provided informed consent. Potential participants self-identified as being eligible and interested in being included, after receiving the participant information sheet. The interviews explored their experience of working in SMS and supporting people who have misused OTC/POM, and potential changes to current SMS provision. Thematic analysis of the audio-recording transcripts was undertaken using NVivo®. This research was funded by a Research Award from Pharmacy Research UK and the College of Mental Health Pharmacy [PRUK_CMHP-2019-2-RG]. This research was approved by Humankind/EDP and Aston University’s Life and Health Sciences Ethics Committees (ID#1655). Results Organising interviews was challenging due to pandemic-related work pressures, between October 2020 and January 2021. Thematic analyses of twenty SMS staff transcripts was undertaken and data saturation was thought to have been achieved. Three overarching themes were identified: characteristics of OTC/POM misuse; different groups of people; and negative experiences (with six sub-themes: lack of awareness of risk of harm; unmanaged health conditions; withdrawal symptoms; side-effects; problematic behaviours; and treatment pathways). Oral dependent use of opioids (especially codeine products), benzodiazepines and gabapentinoids predominated. Polypharmacy and the use of other substances sometimes occurred. OTC/POM misuse was associated with a wide range of adverse socioeconomic, physical, and psychological effects. Unmanaged withdrawal symptoms caused concern, contributed to perpetuating misuse, and sudden cessation in supplies created risks. Discussion and Conclusion This study had a unique focus on the experiences of third sector English SMS staff. OTC/POM misuse (and withdrawal symptoms) should be routinely enquired about during healthcare reviews, and tailored harm reduction, pharmacological and psychosocial interventions offered. Increased awareness, vigilance for associated safeguarding issues, and more training is required. SMS should sensitively consider how to incorporate the views of staff with lived experience to further optimise service delivery co-production. As staff were all employed by the same SMS provider, future research, conducted in SMS operated by other providers, and covering a wider geography, may enable more information to be shared, more participants to be recruited, and the results more generalisable. Repeat interviews and member-checking may improve assurance in the findings. The possible need for different SMS for those who only misuse OTC/POM without exacerbating stigma requires further exploration. Future research should identify if demographic characteristics and treatment needs differ by OTC/POM type.

Exploring facilitators and barriers to scope of practice expansion with Pharmacist independent prescribers in North Wales: a qualitative study

Abstract Introduction Independent non-medical prescribing allows qualified nurses, pharmacists and other healthcare professionals to prescribe within their competence, which is initially narrow in scope. Previous research identified that this competence requirement has potential to limit pharmacist independent prescribers’ (PIPs) ability to expand their prescribing scope1. The Royal Pharmaceutical Society has published guidance for PIPs on expanding scope of practice after qualification2. Research asking how, why and what factors affect the process of scope expansion is lacking. Aim To explore the reasons why PIPs may or may not expand their prescribing scope of practice after qualification and what factors may prevent or enable this. Methods A qualitative semi-structured interview study was utilised. Participants were PIPs working within North Wales who self-reported at least 2 years’ experience as a prescriber, prescribing at least monthly and had expanded their scope of practice since qualification. Recruitment was via gatekeepers. The study obtained ethical approval from Cardiff University School of Pharmacy Research Ethics Committee (Reference 2324-03) and was registered with Betsi Cadwaladr University Health Board. Purposive sampling ensured inclusion of pharmacists from multiple pharmacy sectors. Interviews were face-to-face or online and recorded on MSTeams®. Deidentified verbatim transcripts were analysed via inductive thematic analysis. Results Ten participants were interviewed, from a mixture of hospital, primary care, out of hours and community pharmacy sectors. Themes identified included intrinsic factors (experience and attitude) and extrinsic factors (support, service factors, governance and workplace social context). Experience sub-themes included confidence, a holistic approach and awareness of professional boundaries as facilitators for scope expansion. Attitude included being motivated and fulfilment in the role. Support was a key factor including time, funding, mentorship, peer and managerial support – all identified as facilitators and lack of each as a barrier. Other support sub-themes included structured training programmes, such as the All Wales 111 competency framework, easy access to experienced colleagues for advice on cases and space for reflective thinking, either as a team or with a mentor. Governance was identified as both a barrier and facilitator, with some appreciating the structure of local prescribing policies whilst others found it restrictive. Service factors included new roles, an expectation of the role to prescribe for multiple conditions, such as in 111 or the community pharmacy independent prescribing service, changes in team skill mix, service review and patient requests. Workplace social context that facilitated scope expansion included independent prescriber role models, nurturing teams and working within a multidisciplinary team. A lack of multidisciplinary working, such as lone working in community pharmacy, was seen as a barrier. Discussion / Conclusion Themes identified align with previously published literature and models on expertise development in independent prescribing(4), suggesting that expanding scope of prescribing aligns with expert practice development needs. This exploratory study highlights factors that PIPs found both helpful and a hindrance for expanding their prescribing scope of practice, although limited by the small sample size. Further research is needed to corroborate these findings with other professions and in other parts of the UK before incorporating into future guidance.

EXaminaTion of cRitical cAre PHArmacist pRoductivity MetricS (EXTRA‐PHARMS): The clinical pharmacist's perspective

AbstractBackgroundCritical care pharmacists are well‐established, valuable members of the intensive care unit interprofessional team with unique skills to perform comprehensive medication management in complex critically ill patients. However, standardized and consequential productivity metrics for critical care pharmacists have not been established.ObjectiveTo characterize the utilization and perception of contemporary critical care pharmacy productivity metrics utilized among individual institutions.Design, Setting, and ParticipantsAn electronic survey was distributed to critical care pharmacist members of the Society of Critical Care Medicine Clinical Pharmacy and Pharmacology Section and the American College of Clinical Pharmacy Critical Care Practice and Research Network.Main Outcomes and MeasuresThe survey included 23 questions to assess institution demographics, individual respondent demographics, institution practices, and individual respondent perceptions about the value of critical care pharmacist productivity metrics.ResultsA total of 204 critical care pharmacists, largely from the United States, responded to the survey between July and November 2022. Institutional metrics captured by more than 50% of the respondents' institutions included order verification rate/number of orders verified (60%), number of clinical interventions (57%), and intravenous to enteral product interchanges (52%). Of these metrics, critical care pharmacists only agreed with the value of the number of clinical interventions, were indifferent to the value of intravenous to oral product interchanges, and disagreed with the value of order verification rate/number of orders verified.ConclusionsSignificant discrepancies exist between institutional productivity metric practices and their perceived value and utility among critical care pharmacists.

Collaborative pharmacy research across integrated health systems: A purpose and promise for opportunities to study the complete medication-use process.

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.

Leveraging Numerical Simulation Technology to Advance Drug Preparation: A Comprehensive Review of Application Scenarios and Cases.

Numerical simulation plays an important role in pharmaceutical preparation recently. Mechanistic models, as a type of numerical model, are widely used in the study of pharmaceutical preparations. Mechanistic models are based on a priori knowledge, i.e., laws of physics, chemistry, and biology. However, due to interdisciplinary reasons, pharmacy researchers have greater difficulties in using computer models. In this paper, we highlight the application scenarios and examples of mechanistic modelling in pharmacy research and provide a reference for drug researchers to get started. By establishing a suitable model and inputting preparation parameters, researchers can analyze the drug preparation process. Therefore, mechanistic models are effective tools to optimize the preparation parameters and predict potential quality problems of the product. With product quality parameters as the ultimate goal, the experiment design is optimized by mechanistic models. This process emphasizes the concept of quality by design. The use of numerical simulation saves experimental cost and time, and speeds up the experimental process. In pharmacy experiments, part of the physical information and the change processes are difficult to obtain, such as the mechanical phenomena during tablet compression and the airflow details in the nasal cavity. Therefore, it is necessary to predict the information and guide the formulation with the help of mechanistic models.

Structural study of the intrinsically disordered tardigrade damage suppressor protein (Dsup) and its complex with DNA

Studies of proteins, found in one of the most stress-resistant animals tardigrade Ramazzottius varieornatus, aim to reveal molecular principles of extreme tolerance to various types of stress and developing applications based on them for medicine, biotechnology, pharmacy, and space research. Tardigrade DNA/RNA-binding damage suppressor protein (Dsup) reduces DNA damage caused by reactive oxygen spices (ROS) produced upon irradiation and oxidative stresses in Dsup-expressing transgenic organisms. This work is focused on the determination of structural features of Dsup protein and Dsup-DNA complex, which refines details of protective mechanism. For the first time, intrinsically disordered nature of Dsup protein with highly flexible structure was experimentally proven and characterized by the combination of small angle X-ray scattering (SAXS) technique, circular dichroism spectroscopy, and computational methods. Low resolution models of Dsup protein and an ensemble of conformations were presented. In addition, we have shown that Dsup forms fuzzy complex with DNA.

The Languages of Love Support Group: Exploring quality of life and relationship satisfaction among couples experiencing cancer.

206 Background: Based on Dr. Gary Chapman’s The Five Love Languages (5LL), love is given and received in different ways. By identifying preferences for reciprocating love, relationships are enhanced through strengthened bonds and improved communication. Study goals were to optimize quality of life and reduce pain through improved dyadic communication via support group curriculum adapted from Dr. Chapman’s work. Methods: A research collaboration was established between an academic pharmacy research team and a large community oncology practice. A group of Masters prepared Social Workers (MSWs) within the oncology practice developed a virtual 6-week, cancer specific curriculum targeting the patient-partner couple (dyad). Participants completed 5LL quiz to determine their preferred love language. In each group session facilitated by MSWs, dyads were educated on each love language meaning (words of affirmation, acts of service, receiving gifts, quality time, physical touch) and potential impact following a cancer diagnosis. Weekly sessions included collective discussion and breakout groups consisting of patients and partners separately. Participants took a researcher-designed, pre- and post-test survey. Participants shared their preferred love language and were encouraged to perform actions accordingly. Dyads were mailed infographics with application examples for each love language and received a welcome starter kit including $50 of items. Results: A pilot group of 24 dyads consisting of 3 cohorts were enrolled in the 6-week intervention. Eleven dyads completed pre- and post-tests (45.8%); 100% of dyads were married, greater than 50% more than 20 years. Greater than 80% of participants were 50 years or older, greater than 70% White; 81.8% of patients female and 63.3% of partners male. Patient relationship satisfaction increased significantly (p<0.10) while trend for improved partner relationship satisfaction was not significant. There was a trend of decreased patient depression and anxiety despite patients’ reported pain increasing significantly (p<0.10). The comments regarding intervention were overwhelmingly positive. Conclusions: Educating dyads within the 5LL virtual support group demonstrated a novel and effective way to provide emotional support and enhance intimate relationships. Through this innovative group, participants learned to identify and express partners’ love language. Pilot intervention shows how this approach is useful in improving relationship satisfaction during the cancer journey. Following group participation, patients also reported increased quality of life and decreased depression and anxiety even while reporting increased pain. Based on this evidence, a couples support group constructed from the 5LL paradigm is a promising approach to improve the quality of life of cancer patients.

Data-Driven Clinical Pharmacy Research: Utilizing Machine Learning and Medical Big Data.

To conduct clinical pharmacy research, we often face the limitations of conventional statistical methods and single-center observational study. To overcome these issues, we have conducted data-driven research using machine learning methods and medical big data. Decision tree analysis, one of the typical machine learning methods, has a flowchart-like structure that allows users to easily and quantitatively evaluate the occurrence percentage of events due to the combination of multiple factors by answering related questions with Yes or No. Using this feature, we first developed a risk prediction model for acute kidney injury caused by vancomycin, a condition we frequently encounter in clinical practice. Additionally, by replacing the prediction target from a binary variable (i.e., presence or absence of adverse drug reactions) to a continuous variable (i.e., drug dosage), we built a model to estimate the initial dose of vancomycin required to reach the optimal blood level recommended by guidelines. We found its accuracy to be better than that of conventional dose-setting algorithms. Moreover, employing Japanese medical big data such as the claims database helped us overcome the major limitations of conventional clinical pharmacy research such as institutional bias caused by single-center studies. We demonstrated that the combined use of machine learning and medical big data could generate high-quality evidence leveraging the strengths of each approach. Data-driven clinical pharmacy research using machine learning and medical big data has enabled researchers to surpass the limitations of conventional research and produce clinically valuable findings.

A Role of Artificial Intelligences in Drug Discovery and Drug Development – A Critical Review.

Artificial intelligence (AI) is lowering the period and cost of the medication research and discovery process Artificial Intelligence is a revolution of medical research in pharmaceutical companies. In a review article, we give a summary of the many artificial intelligence tools of machine learning (ML) and deep learning (DL) techniques that will be used in drug research and discovery in the future. AI techniques and tools are more specifically designed or better programmed to mimic the operations of the human brain. AI is frequently used in drug discovery for de novo drug creation, virtual screening, reaction prediction, and de novo protein design. In addition, the application of AI and techniques of AI. ML is a disease diagnosis, de novo drug design, drug prediction for diseases, and big data prediction using ANN, CNN, and SNN, as well as deep learning. Furthermore, the function, applications, and methods of AI. Technological hurdles also face the contemporary XAI, and “low level” molecular representations (such as SMILES strings) that are useful for machine learning and AI tools are ‘deep chem’ in drug development several cutting-edge methods referred to as Knowledge Base Systems (KBS). The AI-based nanorobots are drug discovery on creating implantable nanorobots for the targeted delivery of medications and genes, factors including sustained release, dose modification, and control release need to be taken into consideration. Finally recent development of ML and DL techniques and AI models are more useful in the drug development and drug discovery process.

Programmable Lanthanide Metal-Organic Framework for Ultra-Efficient Nucleic Acids Extraction and Interaction Analysis.

Efficient, mild, and reversible adsorption of nucleic acids onto nanomaterials represents a promising analytical approach for medical diagnosis. However, there is a scarcity of efficient and reversible nucleic acid adsorption nanomaterials. Additionally, the lack of comprehension of the molecular mechanisms governing their interactions poses significant challenges. These issues hinder the rational design and analytical applications of the nanomaterials. Herein, we propose an ultra-efficient nucleic acid affinity nanomaterial based on programmable lanthanide metal-organic frameworks (Ln-MOFs). Through experiments and density functional theory calculations, a rational design guideline for nucleic acid affinity of Ln-MOF was proposed, and a modular and flexible preparation scheme was provided. Then, Er-TPA (terephthalic acid) MOF emerged as the optimal candidate due to its pore size-independent adsorption and desorption capabilities for nucleic acids, enabling ultra-efficient adsorption (about 150% mass ratio) within 1 min. Furthermore, we elucidate the molecular-level mechanisms underlying the Ln-MOF adsorption of single- and double-stranded DNA and G4 structures. The affinity nanomaterial based on Ln-MOF exhibits robust nucleic acid extraction capability (4-fold higher than commercial reagent kits) and enables mild and reversible CRISPR/Cas9 functional regulation. This method holds significant promise for broad application in DNA/RNA liquid biopsy and gene editing, facilitating breakthroughs in analytical chemistry, pharmacy, and medical research.

Increasing pharmacy research activity and engagement: SW Pharmacy Research Network

The number of pharmacy professionals engaged in research‐oriented academic or clinical positions remains low. This article discusses recent efforts that have been initiated and implemented in the South West of England aimed at motivating pharmacy professionals to participate in research, with a special focus on considering clinical academic career paths.

Perceptions and outcomes of a nationwide remote pharmacy mentorship program

AbstractIntroductionMentorship is crucial for professional development in health care. However, the outcomes of national remote mentorship programs in pharmacy remain largely unexplored. This study evaluates the perceptions and experiences of student pharmacists, residents, fellows, and nontrainee pharmacists in such a program.ObjectivesThis study aimed to assess the perceptions and outcomes of a nationwide remote pharmacy mentorship program designed for student pharmacists, residents, and fellows. It explores the efficacy, benefits, and barriers within a national pharmacy professional organization mentorship program.MethodsThe mentor and mentee experiences in the American College of Clinical Pharmacy (ACCP) Ambulatory Care Practice and Research Network (PRN) from program years 2019–2022 were assessed using an anonymous online survey, employing a mixed‐methods approach. The survey featured quantitative Likert scale and qualitative free‐response questions. In addition, publicly available online sources provided data for postprogram placement outcomes of learner participants in the program. Summary statistics were computed from the quantitative data, and content analysis was applied to the qualitative data.ResultsOf the 356 invited program participants, 48 mentors (32.7%) and 18 mentees (8.6%) responded to the survey. Most respondents agreed or strongly agreed on the program's effectiveness, contributing to a high postprogram placement rate in residencies and ambulatory care positions, emphasizing the program's success in supporting career progression. Respondents recognized significant benefits like career development and professional satisfaction. Notable demographic disparities, especially in age, gender, and race, were observed among participants. The study also identified logistical challenges that impeded the program's full potential.ConclusionDespite limitations, including a low number of responses, the study revealed that remote mentorship may positively affect professional development and well‐being. The data supports the program‐impacted respondent involvement and professional growth. Moreover, these findings suggest the need for further research to address the program barriers and disparities in participation.

Exploring the perceptions of faculty members about research courses in undergraduate pharmacy curriculum: A qualitative study.

The commitment of pharmacy graduates to patient care and research is crucial to advancing pharmaceutical science and practice. Consequently, the value of involving undergraduate pharmacy students in research has been increasingly recognized. Given that the College of Pharmacy at Qatar University offers two undergraduate pharmacy research courses, it is relevant to explore the perception of faculty members of the delivery, impact, facilitators, barriers, and suggested improvements in these courses. This exploration will help to improve the existing curriculum and to highlight the prospective impact of student involvement in undergraduate pharmacy research courses on the personal and professional growth of students, as well as on the progressive evolution of the pharmacy profession. A qualitative exploratory case study was performed in which five virtual focus groups were conducted. All eligible faculty members from the clinical pharmacy and pharmaceutical science departments with experience supervising students who had taken one or two undergraduate pharmacy research courses were invited to participate. The focus group questions were based on the Theoretical domain framework of behavioral determinants. Verbatim transcription was performed, and the collected data were thematically analyzed using the computer-assisted coding software NVivo®. Of the 26 eligible faculty members, 21 participated in this study. Five deductive themes were identified: social professional role and influences, beliefs about capabilities, skills, beliefs about consequences and goals, and environmental resources and behavioral regulations. Overall, faculty members identified themselves as assessors and mentors. Participants expected students to possess independence, responsibility, and motivation. They believed that students generally required more practical research skills. Several benefits of incorporating students into undergraduate research have been highlighted, including increased publication productivity and quality. However, several hurdles to undergraduate research in pharmacy have been identified, including limited resources, limited timeframes, and sometimes delayed ethical approval. Faculty members expressed optimism regarding the undergraduate research courses. However, some logistical concerns, including the lengthy ethical approval process and resource availability, must be addressed to optimize the effectiveness of these courses.