Drug, Healthcare And Patient Safety[JOURNAL]
Sun
200 papers
Current Status and Research Trends in Deprescribing: A Bibliometric Review.
Shi C, Li X, Wu Y … +2 more , Qin W, Liu L
Drug Healthc Patient Saf · 2025 · PMID 41278245 · Full text
BACKGROUND: Polypharmacy has emerged as a major global public health concern. To mitigate its adverse effects, deprescribing has been introduced and integrated into clinical practice. This study aims to analyze the curre...
BACKGROUND: Polypharmacy has emerged as a major global public health concern. To mitigate its adverse effects, deprescribing has been introduced and integrated into clinical practice. This study aims to analyze the current research landscape and identify emerging trends in deprescribing from a bibliometric perspective. METHODS: Relevant studies on deprescribing published prior to December 2024 were retrieved from the Web of Science Core Collection database. Bibliometric analysis and visualization of co-authorship, citation, co-citation, co-occurrence, and burst detection were performed using VOSviewer, CiteSpace, and Bibliometrix. RESULTS: A total of 1809 publications were identified, with a marked increase over the past decade. The field is dominated by contributions from developed countries, notably the United States, Australia, and Canada. Studies primarily focus on chronic conditions, such as psychiatric disorders, cardiometabolic diseases, and chronic pain, and the medications used to treat them. Influential publications highlighted barriers and facilitators of deprescribing, deprescribing tools, and deprescribing interventions and their associated outcomes. Burst detection analysis pointed to increasing attention on pharmaceutical care and implementation science. CONCLUSION: This study presents the first comprehensive bibliometric overview of deprescribing. The findings demonstrate that the field has grown rapidly but remains dominated by developed countries and a limited set of chronic diseases. The integration of implementation science frameworks emerges as a promising approach to enhance the design and evaluation of deprescribing interventions. Future studies should broaden their scope to include a wider range of diseases and medications, and encourage greater participation from developing countries.
Facilitators and Barriers to Prescription Medication Sharing: A Qualitative Study from the Public's Perspective in Saudi Arabia.
Alhomoud F, Alhaddad K, Aldaqdouq Y … +7 more , Aljuzair ZH, Alhomoud FK, Alsaleh FM, Alfageh B, Alrasheed MA, Aladwani M, Almanasef M
Drug Healthc Patient Saf · 2025 · PMID 41262341 · Full text
BACKGROUND: Prescription medication sharing (PMS) poses significant health risks, including side effects, delayed care, and worsening of illness. Despite these risks, evidence explaining why people share or avoid sharing...
BACKGROUND: Prescription medication sharing (PMS) poses significant health risks, including side effects, delayed care, and worsening of illness. Despite these risks, evidence explaining why people share or avoid sharing prescription medicines remains scarce. To address this gap, the present study explored the perceived facilitators and barriers to PMS among the public in the Kingdom of Saudi Arabia (KSA) using a qualitative approach. METHODS: A qualitative study using face-to-face, semi-structured interviews was conducted in the Eastern Province with 60 participants, selected through a convenience sampling strategy. Eligibility criteria included the ability to communicate in Arabic or English, age ≥18 years, and taking a prescribed medication. Interviews continued until data saturation was achieved. Audio recordings were transcribed verbatim and analysed thematically using QSR NVivo 10 software. RESULTS: The study included 60 participants. Most participants were female, younger adults, and university educated. Thematic analysis identified two main themes: facilitators and barriers of PMS. Facilitators included saving time and cost, limited access to medicines or healthcare services, availability of leftover medicines, socio-cultural factors, and prior experience or knowledge about an illness and its treatment. Barriers included unsafe or ineffective treatment, awareness of public health risks, risk of dependence, and risk of non-adherence among lenders. These themes reflected a complex interaction of individual, cultural, and system-level influences. While some drivers aligned with international findings, others were more specific to the Saudi context, such as over-prescribing by doctors, brand preferences, misuse of insurance, medicine accumulation, strong family ties, cultural expectations of generosity, stigma-related communication gaps, and personal illness experiences. CONCLUSION: This study provides the first qualitative insight into PMS in Saudi Arabia, highlighting how cultural norms, family dynamics, and healthcare system factors shape this behavior. The findings underscore the need for culturally informed policies and public health strategies to reduce risks and promote safe medication practices. Pharmacist-led counselling and community-based campaigns focused on safe medication use and proper disposal can further support safer medication practices and reduce the risks associated with PMS.
Establishing Interprofessional Medication Reviews in Home Care Patients - A Feasibility Study.
Meyer-Massetti C, Sommer A, Kaiser E … +10 more , Peschak AM, Preisig M, Aubert CE, Mäder RD, Ramseier L, Riesen IS, Lettieri-Amstutz S, Rölli D, Schönenberger N, Meier CR
Drug Healthc Patient Saf · 2025 · PMID 41084732 · Full text
BACKGROUND: Medication-related problems are especially frequent among home-care patients, who are predominantly older, multimorbid, polymedicated and interact with multiple professionals, necessitating timely, complete a...
BACKGROUND: Medication-related problems are especially frequent among home-care patients, who are predominantly older, multimorbid, polymedicated and interact with multiple professionals, necessitating timely, complete and accurate drug information communication. AIM: To pilot a standardised approach to interprofessional home-care medication management focusing on deprescribing. METHODS: Home-care patients, cared for in their own homes by one professional nursing agency in the city of Bern, Switzerland, aged ≥64 and taking ≥4 prescribed medications were assessed for medication-related risk with the interprofessional, 10-item doMESTIC RISK tool. Community pharmacists performed structured medication reviews for at-risk patients, communicating with primary care physicians via standardised form. RESULTS: Nurses initiated 106 risk analyses (as defined in the process) in consenting patients, with 76 (72%) completed by pharmacists; 30 analyses could not be completed due to missing information. Out of 76 patients with a completed risk assessment, 26 patients did not need a medication review; one score was missing. The 49 patients qualifying for a medication review were on average 84.0 ± 7.7 years old and took a mean of 11.2 ± 4.5 prescribed medications regularly and 2.8 ± 3.5 prescribed as-needed medications. Pharmacists identified a median of two problems per patient, suggesting 64 potential interventions. Forty-three priority interventions for 18 patients were communicated to physicians, mostly dose reduction (27%) and therapy cessation (23%). Despite providing comprehensive information in the requests, physicians only reacted to 50% of pharmacists' recommendations (9/18 patients), accepting 57% of pharmacists suggestions in nine patients, predominantly deprescribing (nine medications). CONCLUSION: While pharmacists identified medication improvements through structured medication reviews, limited access to clinical information and insufficient communication between health care professionals were key barriers. Strengthening interprofessional collaboration and structured communication through shared platforms allowing clinical data exchange is essential to optimizing medication management in home-care. Clarification of the roles of the team members must be improved.
Establishing of a National Diagnostic Reference Level for Radiation Dose in Digital Paediatric Pelvic X-Rays in Jordan: A Multicenter Retrospective Study.
AlHawadi M, Ayasrah M
Drug Healthc Patient Saf · 2025 · PMID 41064469 · Full text
BACKGROUND: Paediatric pelvic X-rays are essential for diagnosing injuries and developmental abnormalities but pose radiation risks to sensitive children. Dose Reference Levels (DRLs) play a critical role in optimising r...
BACKGROUND: Paediatric pelvic X-rays are essential for diagnosing injuries and developmental abnormalities but pose radiation risks to sensitive children. Dose Reference Levels (DRLs) play a critical role in optimising radiographic procedures, ensuring both safety and high-quality imaging. OBJECTIVE: This research aimed to establish a National Dose Reference Level (NDRL) for digital paediatric pelvic X-rays in Jordan to optimise radiation doses, improve diagnostic accuracy, and minimise risks. METHODS: A Multicenter retrospective analysis was performed on paediatric Anterior-Posterior (AP) digital pelvic X-rays from various 12 Jordanian healthcare institutions. Parameters including Kilovoltage peak (kVp), milli Ampere second (mAs), and Focal to Skin Distance (FSD) were collected. Entrance Surface Dose (ESD) was indirectly calculated following international guidelines. RESULTS: The study analysed 1,674 paediatric pelvic X-rays, finding a mean ESD of 0.69 milli-Gray (mGy). The 75th percentile ESD, or (DRL), was 0.612 mGy overall, with age-specific DRLs of 0.265 mGy (0 to <1 year), 0.382 mGy (1 to <5 years), 0.704 mGy (5 to <10 years), and 0.995 mGy (10 to ≤15 years). CONCLUSION: The study revealed age-dependent variations and notable disparities in radiation doses among various healthcare institutions in Jordan. Establishing the NDRL of 0.612 mGy provides a benchmark for dose optimisation and aligns Jordan's practices with international standards. The findings can guide national radiation protection policies and clinical guidelines, enhance paediatric imaging practices, and minimise unnecessary radiation exposure.
Assessing Readability and Usability of Electronic Medicine Package Leaflets in South Korea: A Mixed-Methods Study.
Yang J, Kwon K
Drug Healthc Patient Saf · 2025 · PMID 40949499 · Full text
PURPOSE: E-labeling, which refers to delivering medicine package leaflets electronically, has been introduced in several countries as an alternative to printed leaflets. However, little is known about whether e-labeling...
PURPOSE: E-labeling, which refers to delivering medicine package leaflets electronically, has been introduced in several countries as an alternative to printed leaflets. However, little is known about whether e-labeling improves the readability and usability of medicine information from the patient's perspective. This study aimed to evaluate the readability and usability of e-labeling compared to traditional paper leaflets in South Korea. METHODS: We conducted a mixed-methods user testing involving 77 adult participants recruited via convenience sampling. Participants were assigned to evaluate either a paper leaflet or e-labeling for a prescription antihypertensive or a non-prescription NSAID. Participants evaluated the printed leaflets or the corresponding PDF files by accessing them with their own mobile phones. Quantitative measures included traceability (accuracy in finding information), tracking speed (time taken to find information), and comprehension (whether the content was well understood). Semi-structured interviews were conducted to explore user experiences, perceived barriers, and preferences for e-labeling adoption. RESULTS: Across both drug types, e-labeling showed lower performance compared to paper leaflets. For the antihypertensive, traceability declined by 4.7%, tracking speed by 0.08 points, and comprehension by 3.3%. For the NSAID, these declines were 7.0%, 0.19 points, and 5.7%, respectively. Qualitative findings revealed mixed perceptions to e-labeling, with some valuing search functions and adjustable text size, while others highlighted difficulties navigating content and reduced accessibility. Participants emphasized the need for improved formatting, intuitive structure, and better utilization of digital features. CONCLUSION: The current e-labeling format may not sufficiently meet patients' needs for medicine information. To support successful implementation, e-labeling should be redesigned with a focus on patient-centered principles, ensuring equitable access, and being tested in real-world settings. Education and awareness campaigns on how to use e-labeling would provide practical guidance and encourage acceptance among patients. These findings provide patient-centered evidence to inform improvements in e-labeling policies and design.
Knowledge Level and Attitudes of Healthcare Professionals Regarding Patient Safety in a Tertiary Hospital in Somalia: A Cross-Sectional Study.
Hilowle FM, Mohamud FA, Osman IM … +4 more , Mohamud SM, Doğan S, Sahal SM, Aden SA
Drug Healthc Patient Saf · 2025 · PMID 40901246 · Full text
BACKGROUND: Patient safety culture involves shared values, perceptions, and attitudes regarding safety within healthcare organizations, aiming to minimize preventable harm to patients. This concept has gained prominence...
BACKGROUND: Patient safety culture involves shared values, perceptions, and attitudes regarding safety within healthcare organizations, aiming to minimize preventable harm to patients. This concept has gained prominence worldwide, especially in Africa, where recent efforts focus on patient safety as a fundamental component of healthcare delivery. Despite progress, research into patient safety culture and its influencing factors remains limited in low-resource settings. OBJECTIVE: This study assessed the knowledge and attitudes of healthcare professionals toward patient safety at a tertiary hospital. METHODS: A cross-sectional study was conducted involving healthcare workers at the hospital. Data was collected using a structured self-administered questionnaire, capturing socio-demographic information, patient safety knowledge, and attitudes. Statistical analysis was performed using IBM SPSS Statistics 27, employing descriptive statistics and Pearson's chi-square test to evaluate differences between socio-demographic factors and patient safety attitudes. RESULTS: Among 300 respondents, 59% were male, and 65% were aged 21-30 years. Nurses accounted for 41% of participants. The majority (86%) reported sufficient patient safety knowledge, with 82% supporting patient safety inclusion in undergraduate education, furthermore 44.8% exhibited positive attitudes. Age and professional experience were significantly associated with positive patient safety attitudes (P = 0.012 and P = 0.003, respectively). Most respondents (74.7%) reported encountering medical errors, primarily technical errors, indicating a need for targeted training interventions. CONCLUSION: Despite adequate self-reported knowledge, positive attitudes toward patient safety were limited-particularly among younger and less experienced professionals. These findings indicate that improving patient safety in Somali healthcare settings requires not only educational initiatives but also system-level interventions, including leadership support, non-punitive error reporting, and strategies that empower frontline staff. Future research should explore how these factors influence long-term safety culture development.
Impact of Dexmedetomidine on Hospital and Intensive Care Unit Stay Duration in Adult Traumatic Brain Injury Patients: A Systematic Review.
Alaifan T, Sakhakhni A, Khojah A … +3 more , Alraddadi EA, Alkhaibary A, Alqahtani AM
Drug Healthc Patient Saf · 2025 · PMID 40665993 · Full text
BACKGROUND: Traumatic brain injury is a pressing public health issue worldwide that leads to profound disability and mortality. Medical guidelines recommend sedation and analgesia, with dexmedetomidine emerging as a prom...
BACKGROUND: Traumatic brain injury is a pressing public health issue worldwide that leads to profound disability and mortality. Medical guidelines recommend sedation and analgesia, with dexmedetomidine emerging as a promising option, given its unique pharmacological properties. However, the effect of dexmedetomidine in reducing the length of hospital stay in patients with traumatic brain injury remains unclear. This systematic review aimed to assess the effect of dexmedetomidine administration on traumatic brain injury management based on severity, with a specific focus on hospital and intensive care unit length of stay. METHODS: A systematic search following the PRISMA guidelines identified relevant studies from various databases. Eligible studies involving adult patients with traumatic brain injury and dexmedetomidine interventions were selected and assessed for the risk of bias. The extracted data included the study characteristics, intervention details, and outcome measures. RESULTS: Eight studies, three of which were randomized controlled trials, met the inclusion criteria. Dexmedetomidine has shown potential benefits in mitigating traumatic brain injury length of stay, particularly in patients with severe traumatic brain injury. However, the findings on hospital length of stay varied, preventing a definitive conclusion regarding the effectiveness of dexmedetomidine in reducing length of stay. Heterogeneity among the studies was the main factor in the reported variable results. CONCLUSION: Dexmedetomidine has a promising role in traumatic brain injury management with evidence suggesting reduced intensive care unit length of stay with dexmedetomidine administration. A comprehensive understanding of dexmedetomidine dosing strategies and their long-term effects is crucial to optimize patient outcomes. A multifaceted approach to traumatic brain injury management will help enhance the therapeutic utility of dexmedetomidine and improve the care and outcomes of traumatic brain injury patients worldwide.
Adverse Effects Following Immunisation and Vaccine Hesitancy: A Qualitative Study in a South Indian District.
Gopalan RB, Babu BV, Sarma S K … +1 more , John RP
Drug Healthc Patient Saf · 2025 · PMID 40548049 · Full text
BACKGROUND: Parental perceptions and concerns about vaccine safety and 'adverse effects following immunisation' (AEFI) are the reasons for vaccine hesitancy. This study aimed to understand how these vaccine-related conce...
BACKGROUND: Parental perceptions and concerns about vaccine safety and 'adverse effects following immunisation' (AEFI) are the reasons for vaccine hesitancy. This study aimed to understand how these vaccine-related concerns have become significant determinants of vaccine decision-making among non-vaccinating parents in the Alappuzha district of Kerala, India. The healthcare providers' views in this regard are also reported. METHODS: This is a qualitative study. In-depth interviews were conducted with informants from 110 households having non-immunised/partly-immunised children. In addition, 18 healthcare providers were interviewed. Thematic analysis using the reflective thematic method was carried out. RESULTS: Parents reported incidences of minor events of AEFI and are hesitant to continue vaccination in circumstances when children need medical treatment. AEFI incidents within the family have seriously hampered the trust in vaccines. Parents have concerns about multiple vaccinations and have misconceptions about the content of vaccines. Other concerns that lead to hesitancy are vaccine-related infertility, polio infection after polio vaccination and autism due to vaccination. Healthcare providers reported that there were no serious incidents that needed hospitalisation. Health workers opined that informing parents about AEFIs and preparing them is better. CONCLUSION: The study reported that AEFIs are a barrier to vaccine acceptance. It warrants the need to build trust in vaccines and the vaccination process. Transparent communication with the beneficiaries is crucial. AEFI monitoring and reporting should be an essential component of efforts to minimise vaccination hesitancy.
Expert Consensus on Vitamin B6 Therapeutic Use for Patients: Guidance on Safe Dosage, Duration and Clinical Management.
Schellack N, Yotsombut K, Sabet A … +3 more , Nafach J, Hiew FL, Kulkantrakorn K
Drug Healthc Patient Saf · 2025 · PMID 40395441 · Full text
PURPOSE: Vitamin B6 is a crucial water-soluble vitamin found in many foods and is involved in numerous physiological processes, including neurotransmitter synthesis and nervous system function. Although essential for ove...
PURPOSE: Vitamin B6 is a crucial water-soluble vitamin found in many foods and is involved in numerous physiological processes, including neurotransmitter synthesis and nervous system function. Although essential for overall health, both deficiency and excessive intake of vitamin B6 may lead to health complications, particularly peripheral neuropathy. This consensus statement aims to provide healthcare professionals with clear guidance on the safe and effective use of vitamin B6, focusing on its benefits, risks, recommended dosages, and treatment course. METHODS: This consensus statement was developed using a Delphi approach involving a panel of six experts from various medical specialties. This process includes a comprehensive literature review, two rounds of anonymous online surveys, and a virtual expert roundtable discussion. The GRADE approach was used to assess the quality of evidence for each recommendation. RESULTS: The expert panel reached consensus on five key statements. These key recommendations encompass the function of vitamin B6, complications due to vitamin B6 deficiency, dosage recommendations, adverse events, and monitoring guidance throughout the course of treatment. A washout period of 20-40 days for the complete clearance of vitamin B6 was calculated based on pharmacokinetic parameters. A clinical pathway for managing patients who might benefit from vitamin B6 treatment was proposed. CONCLUSION: This consensus statement highlights the importance of recognizing the benefits and potential risks of vitamin B6. While the therapeutic dosage of vitamin B6 can be beneficial to treat deficiency, excessive intake can lead to adverse effects. This statement emphasizes the need for individualized patient care considering factors such as medical history, lifestyle, and potential drug interactions. Further research is needed to establish clearer dosage guidelines, understand the mechanisms of vitamin B6-induced neurological side effects, and optimize patient outcomes.
Enhancing Diagnostic and Patient Safety in Healthcare Systems: Key Insights from the World Patient Safety Day 2024 Commemoration in Uganda.
Turyasiima M, Niwampeire PM, Ssendyona M … +15 more , Akot BG, Acheng M, Katongole SP, Okware J, Tumwikirize J, Mutesasira K, Atepo J, Kaitiritimba R, Epuitai J, Tumwesigye BT, Turinawe G, Mutumba R, Ndifuna M, Musinguzi G, Kemigisa DA
Drug Healthc Patient Saf · 2025 · PMID 40386124 · Full text
BACKGROUND: The 4th World Patient Safety Day (WPSD) 2024 commemoration in Uganda, themed "Improving Diagnosis for Patient Safety", highlighted critical challenges and opportunities in reducing diagnostic errors within he...
BACKGROUND: The 4th World Patient Safety Day (WPSD) 2024 commemoration in Uganda, themed "Improving Diagnosis for Patient Safety", highlighted critical challenges and opportunities in reducing diagnostic errors within healthcare systems. This review synthesizes key insights from the event, focusing on factors contributing to diagnostic inaccuracies, systemic gaps, and actionable strategies for improvement. METHODS: Using a qualitative synthesis approach guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ), we analyzed data from a hybrid webinar (210 participants) and a four-day medical camp (600+ patients served). Thematic analysis identified four key areas: (i) factors influencing diagnostic errors, (ii) the role of laboratory and imaging services in diagnosis error prevention, (iii) existing health system interventions, and (iv) patient empowerment in the diagnostic process. RESULTS: Diagnostic errors in Uganda stem from cognitive biases, systemic inefficiencies (eg, understaffing, inadequate equipment), and financial barriers in private healthcare. Strengthening laboratory capacity, digitizing health records, and enhancing provider-patient communication emerged as pivotal solutions. The Ministry of Health's initiatives such as laboratory accreditation, the 5S quality improvement framework, and patient feedback mechanisms demonstrate progress but require scaling. RECOMMENDATIONS: We propose a multi-level approach: (1) national policies for error reporting and patient safety frameworks, (2) expanded supportive supervision and digitization (eg, EHRs with decision support), (3) stricter regulation of private healthcare, and (4) community engagement to improve health literacy and early care-seeking. CONCLUSION: Reducing diagnostic errors demands systemic reforms, technological integration, and collaborative stakeholder engagement. Uganda's WPSD 2024 insights offer a model for similar low-resource settings to enhance diagnostic accuracy and patient safety.
Comparing Out-of-Pocket Costs and Health-Related Quality of Life Between Sodium-Glucose Cotransporter 2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists in Patients with Type 2 Diabetes.
Hu S, Zanwar PP, Jenkins T … +2 more , Sevak RJ, Jasti BR
Drug Healthc Patient Saf · 2025 · PMID 40302900 · Full text
PURPOSE: To compare the impact of sodium-glucose cotransporter 2 inhibitor (SGLT2 inhibitor), glucagon-like peptide-1 receptor agonist (GLP-1 RA), with or without metformin, on out of pocket and total prescription expend...
PURPOSE: To compare the impact of sodium-glucose cotransporter 2 inhibitor (SGLT2 inhibitor), glucagon-like peptide-1 receptor agonist (GLP-1 RA), with or without metformin, on out of pocket and total prescription expenditure and health-related quality of life (HRQoL) for patients with type 2 diabetes mellitus (T2DM). PATIENTS AND METHODS: This observational study utilized 2017-2021 Medical Expenditure Panel Survey (MEPS) data from patients with T2DM (≥18 years) on SGLT2 inhibitor, GLP-1 RA, with or without metformin, from payer and self-perspective. HRQoL was assessed using physical (PCS) and mental component summary (MCS) scores based on Veterans Rand 12. This study estimated survey-weighed out-of-pocket (OOP) costs for prescription refills and total prescription expenditures. Propensity score matching was used to mitigate selection bias and health expenditures, and HRQoL were compared using the Mann-Whitney -test. P-value thresholds were recalculated using Bonferroni adjustment (Total prescription expenditure or OOP, PCS, and MCS: p=0.017). RESULTS: Patients on GLP-1 RA alone had significantly higher OOP costs than those on SGLT2 inhibitor alone (median: $166.50 vs $81.00, p<0.01). No significant difference existed between the two treatments for total prescription expenditures (median: $9831.53vs. $9458.80, p=0.059), MCS (median:52.41 vs 53.48, p=0.40), or PCS (median: 45.22 vs 44.54, p=0.19). Patients on metformin with GLP-1 RA had higher OOP costs compared to those on SGLT2 inhibitor with metformin (median: $140.40 vs $107.33, p <0.01). There is a significant difference between the combination treatments for total prescription expenditure (median: $9453.96 vs $6711.47, p<0.01), MCS (median: 54.19 vs 54.30, p=0.70), or PCS (median: 45.69 vs 46.08, p=0.55). CONCLUSION: Even though patients on GLP-1 RA have higher OOP costs, the difference in PCS or MCS scores between GLP-1 RA and SGLT2 inhibitor was not significant. Further investigation is needed to study the long-term impact on HRQoL and clinical outcomes.
Fulminant Red Yeast Rice-Associated Rhabdomyolysis with Acute Liver Injury and Hyperkalemia Treated with Extracorporeal Blood Purification Using CytoSorb.
Kurnik M, Markelj T, Žgavc B … +3 more , Hudournik B, Meznarič M, Podbregar M
Drug Healthc Patient Saf · 2025 · PMID 40264460 · Full text
Rhabdomyolysis is a pathophysiological process characterized by the destruction of muscle cells and the release of intracellular contents into the systemic circulation, which can lead to acute kidney injury (AKI) and fai...
Rhabdomyolysis is a pathophysiological process characterized by the destruction of muscle cells and the release of intracellular contents into the systemic circulation, which can lead to acute kidney injury (AKI) and failure. Causes are classified mainly as traumatic and non-traumatic, with statin-induced rhabdomyolysis being widely recognized. Other causes are seldomly reported, one being red yeast rice (RYR) or its active ingredient, monacolin K. We present a life-threatening case of fulminant rhabdomyolysis with severe hyperkalemia, accompanied by ECG changes, tetraparesis, impending compartment syndrome, and liver injury requiring intensive care treatment. Prompt renal replacement therapy was commenced, initially for the treatment of hyperkalemia and subsequently for myoglobin adsorption using the CytoSorb membrane. High doses of corticosteroids were administered as the trigger factor was initially unknown. The condition gradually improved, and the patient regained full functionality. The diagnosis of toxic rhabdomyolysis was confirmed only after the patient was discharged from the intensive care unit. An over-the-counter supplement containing red yeast rice (RYR) was identified as the sole possible triggering factor, with symptoms occurring two days after beginning the self-treatment.
Effectiveness of Quality Use of Medicines (QUM) Programs and Strategies in Saudi Arabia: A Narrative Review.
Aldhafeeri F, Wilson A, Larkin S … +1 more , Aldhafeeri FM
Drug Healthc Patient Saf · 2025 · PMID 40161366 · Full text
BACKGROUND: The high prevalence of chronic diseases, workforce challenges, and growing polypharmacy adversely impact the quality use of medicines (QUM) and health outcomes in Saudi Arabia (SA). The SA Ministry of Health...
BACKGROUND: The high prevalence of chronic diseases, workforce challenges, and growing polypharmacy adversely impact the quality use of medicines (QUM) and health outcomes in Saudi Arabia (SA). The SA Ministry of Health (MOH) has initiated several programs and policies to enhance QUM including a National Medication Safety Program, national clinical guidelines, and technology-based strategies. OBJECTIVE: To assess the published literature on the range, quality, and effectiveness of QUM methods in the SA health system. METHODS: Comprehensive search of electronic databases Scopus, Medline, and PubMed for papers reporting evaluation of QUM interventions or programs in SA. RESULTS: QUM programs involving medication reconciliation, interventions by hospital pharmacists, antibiotics stewardship, technology and staff training are the most commonly used programs reported in SA. Evaluations of several QUM interventions found a significant positive impact on health outcomes, prescribing patterns, chronic disease management, medication safety, and healthcare costs. Medication reconciliation programs reduced discrepancies by up to 20% in some studies. Hospital pharmacist interventions showed high acceptance rates (up to 92%) and improved medication safety. Antibiotic stewardship programs effectively reduced antimicrobial use and costs. Health information technology implementations like electronic health records (EHR), and computerized physician order entry (CPOE) showed mixed results but generally improved medication safety and efficiency. Staff training initiatives enhanced healthcare professionals' knowledge and skills in medication management. CONCLUSION: While SA has national QUM policies and programs, and evidence that individual QUM interventions have significant positive local impact, more large-scale, multi-center studies are needed to provide a comprehensive view of QUM practices. More rigorous evaluations of existing programs and expansion of the range of QUM programs to align with international ones could further improve medication safety and patient outcomes in Saudi Arabia.
Risk of Antipsychotic Initiation Among Older Dementia Patients Initiating Cholinesterase Inhibitors.
Chikermane SG, Li J, Aparasu RR
Drug Healthc Patient Saf · 2025 · PMID 40129750 · Full text
BACKGROUND: Cholinesterase inhibitors (ChEIs) are recognized as first-line therapies for patients with mild-to-moderate dementia. However, there is limited comparative evidence regarding antipsychotic initiation risk amo...
BACKGROUND: Cholinesterase inhibitors (ChEIs) are recognized as first-line therapies for patients with mild-to-moderate dementia. However, there is limited comparative evidence regarding antipsychotic initiation risk among individual ChEIs to manage behavioral symptoms of dementia. OBJECTIVE: This study aims to evaluate and compare the risk of antipsychotic initiation among dementia patients prescribed individual ChEIs. METHODS: This is a retrospective cohort study using the 2009-2018 TriNetX electronic medical records data. Dementia patients aged over 60 years who were incident users of rivastigmine, donepezil, or galantamine with a 12-month washout period were included. Patients with a history of antipsychotic use during baseline and 30 days post-initiation of ChEIs were excluded. Patients were followed up to 12 months to identify the antipsychotic use. A generalized boosted model-based inverse probability treatment weights-adjusted Cox Proportional Hazard (CPH) model was applied to compare the risk of antipsychotic initiation across the different ChEIs. RESULTS: Among the 7,878 eligible dementia patients initiating ChEIs, 89.40% (n=7,043) were incident donepezil users, followed by 8.13% of (n=641) rivastigmine users, and 2.46% (n=194) galantamine users. During the 12-month follow-up, 807 patients (10.24%) initiated antipsychotics. The CPH model showed that rivastigmine users were at an increased risk of antipsychotic use compared to donepezil users (adjusted hazard ratio=1.45, 95% confidence interval: 1.11-1.88). No significant difference was observed in the risk of antipsychotic initiation between galantamine and donepezil users. CONCLUSION: This study found that rivastigmine users were more likely to initiate antipsychotics compared to donepezil users, while no significant difference between galantamine and donepezil users was observed. These findings emphasize the importance of careful medication monitoring and management to prevent prescribing cascades and reduce related adverse effects in dementia patients.
A Nomogram for Predicting Survival in Patients with Respiratory Failure Following Trauma: A Retrospective Study Using the MIMIC-IV Database.
Li P, Wang X, Li L
Drug Healthc Patient Saf · 2025 · PMID 40060036 · Full text
BACKGROUND: Respiratory failure (RF) after trauma is one of the major causes of patients being admitted to the ICU and leads to a high mortality rate. However, we cannot predict mortality rates based on patients' various...
BACKGROUND: Respiratory failure (RF) after trauma is one of the major causes of patients being admitted to the ICU and leads to a high mortality rate. However, we cannot predict mortality rates based on patients' various indicators. The aim of this study is to develop and validate a nomogram for predicting mortality in patients in the intensive care unit (ICU). METHODS: A total of 377 patients from the Medical Information Mart for Intensive Care (MIMIC)-IV database were included in the study. All participants were systematically divided into a development cohort for modelling and a validation cohort for internal validation at a ratio of 7:3. Following patient admission, a comprehensive collection of 30 clinical indicators was performed. The least absolute shrinkage and selection operator (LASSO) regression technique was employed to discern pivotal risk factors. A multivariate Cox regression model was established, and a receiver operating curve (ROC) was plotted, and the area under the curve (AUC) was calculated. Furthermore, the decision curve analysis (DCA) was performed, and the nomogram was compared with the acute physiology score III (APSIII) and Oxford acute severity of illness score (OASIS) scoring systems to assess the net clinical benefit. RESULTS: The indicators included in our model were age, OASIS score, SAPS III score, respiratory rate (RR), blood urea nitrogen (BUN) and hematocrit. The results demonstrated that our model yielded satisfied performance on the development cohort and on internal validation. The calibration curve underscored a robust concordance between predicted and actual outcomes. The DCA showed a superior clinical utility of our model in contrast to previously reported scoring systems. CONCLUSION: In summary, we devised a nomogram for predicting mortality during the ICU stay of RF patients following trauma and established a prediction model that facilitates clinical decision making. However, external validation is needed in the future.
Comparative Analysis of Adverse Drug Reactions Associated with Fluoroquinolones and Other Antibiotics: A Retrospective Pharmacovigilance Study.
Alshareef H, Alenzi KA, Albalawi BR … +6 more , Alanazi RM, Albalawi NS, Alasoufi WS, Alqifari S, Ahmed R, Ali MAS
Drug Healthc Patient Saf · 2025 · PMID 39925396 · Full text
BACKGROUND: Fluoroquinolones (FQs) are among the most popular antimicrobials that are highly effective against various infections. Although FQs are the most frequently used and generally tolerated, there are issues with...
BACKGROUND: Fluoroquinolones (FQs) are among the most popular antimicrobials that are highly effective against various infections. Although FQs are the most frequently used and generally tolerated, there are issues with their safety. This study assessed the rate, severity, seriousness, outcomes, and types of FQs adverse drug reactions (ADRs) in reports submitted to a regional spontaneous ADR database. METHODS: This was a retrospective cross-sectional observational study involving all patients with reported ADRs related to FQs or other antibiotics (ABs) that were submitted to the Regional Pharmacovigilance Center (PVC) database between January 2019 and December 2022. Data were extracted in the form of Saudi ADR from the PVC database, which is consistent with the MedWatch ADR form of the U.S Food and Drug Authority (FDA). RESULTS: In total, 605 ADRs related to antibiotic use were reported. ADRs caused by FQs use were the most frequently reported (177; 29.3%), followed by penicillin (100; 23.4%) and cephalosporin (90; 21%). There was no significant difference in ADRs caused by FQs between men (104; 58%) and women (OR 1.17, 95% CI 0.82-1.67, p=0.386). FQ-related ADRs were more frequent among those over 40 years-old (OR 1.56, 95% CI 1.09-2.22, p=0.015). Most of the detected FQ-related ADRs were of moderate severity (157; 88.7%), required interventions (83; 46.9%), and recovered after receiving medical interventions (154; 87%). Patients who received FQs were fourfold more likely to experience neurological adverse events (OR 4.15, 95% CI 2.48-6.93, p <0.001). CONCLUSION: The FQs drug class exhibited a higher incidence of ADRs than other ABs. Regularly assessing the safety of ABs is crucial to improve public and healthcare providers' awareness of the correct utilization of ABs and to limit the use of FQs to infections that cannot be effectively managed with alternative ABs.
Evaluation of Real-World Evidence to Assess Effectiveness Outcomes of Janus Kinase Inhibitors for Rheumatoid Arthritis: A Systematic Review of US Studies.
Gandy C, Bazzazzadehgan S, Bruera S … +1 more , Huang Y
Drug Healthc Patient Saf · 2025 · PMID 39802749 · Full text
OBJECTIVE: This review summarized the real-world effectiveness outcomes of Janus kinase inhibitors (JAKi) for rheumatoid arthritis (RA) based on observational studies. METHODS: A systematic review followed PRISMA guideli...
OBJECTIVE: This review summarized the real-world effectiveness outcomes of Janus kinase inhibitors (JAKi) for rheumatoid arthritis (RA) based on observational studies. METHODS: A systematic review followed PRISMA guidelines, with searches conducted in PubMed, Embase, and CINAHL from each database's inception to June 2, 2023. Studies were included if they evaluated real-world effectiveness outcomes of JAKi for US RA patients. Search terms included "RA", "JAKi", and "real-world". All citations were imported into COVIDENCE platform. Two reviewers independently performed title/abstract screening and full-text eligibility. For each article, study characteristics and effectiveness measures focusing on treatment pattern, clinical response, and patient-reported outcomes (PROs) of JAKi were extracted. Newcastle-Ottawa Scale (NOS) was utilized to assess the quality of the included articles. RESULTS: In total, 35 studies representing 252-30,556 patients were included. A majority used the administrative claims datasets (n=23, 65.71%), followed by 9 studies using electronic medical record (EMR) data and 3 studies using patient registry databases. Across claims-based studies, adherence, persistence, and effectiveness of JAKi were common outcomes. Adherence rates varied, with a proportion of days covered (PDC) ranging from 0.53 to 0.83 across 11 studies. Persistence of JAKi in RA patients was reported in 14 studies, where the median persistence time in treatment was reported to be between 121-516 days. Six studies applied effectiveness algorithms, with 14.8-26% of patients meeting effective treatment criteria. In addition, the most common measure of clinical response throughout the studies was Clinical Disease Activity Index (CDAI), with 10 articles reporting mean CDAI changes between -4.7 and 5.1. Across 12 studies that measured the PROs, the most prevalent PRO was pain, with the mean change in pain ranging from -9.3 to 8.9 across these studies. CONCLUSION: Real-world studies on JAKi for RA reflect a range of effectiveness measures, illustrating the expanding role of JAKi in clinical practice.
Knowledge, Attitude, and Practice Towards Responsible Self-Medication Among Pharmacy Students: A Web-Based Cross-Sectional Survey in Uganda.
Brian B, Goruntla N, Bommireddy BR … +7 more , Mopuri BM, Easwaran V, Mantargi MJS, Thammisetty DP, Bukke SPN, Yadesa TM, Ayogu EE
Drug Healthc Patient Saf · 2025 · PMID 39802748 · Full text
PURPOSE: Rational self-medication (SM) practice among healthcare students is essential to promote the safe, effective, and economical use of medicines for self-diagnosed conditions. The study aimed to assess pharmacy stu...
PURPOSE: Rational self-medication (SM) practice among healthcare students is essential to promote the safe, effective, and economical use of medicines for self-diagnosed conditions. The study aimed to assess pharmacy students' knowledge, attitude, and practice about responsible self-medication. METHODOLOGY: A cross-sectional online survey was conducted among Ugandan pharmacy students for one month from March 1 to March 31, 2024. The study included students enrolled in diploma, bachelor, and master of pharmacy programs in Uganda. Informed consent was obtained online by asking a question regarding willingness to participate. A non-probable snowball sampling technique was used to recruit students. A pre-validated questionnaire was used to obtain socio-demographics, self-medication practices, knowledge, attitudes, and practices about responsible self-medication. We used binary and multivariable logistic regression analysis to identify the factors associated with KAP regarding responsible self-medication. RESULTS: The prevalence of self-medication practice among pharmacy students was 96.73%. The self-medication is most common in headache (78.97%), cold, and cough (79.91%) illnesses. Painkillers (90.19%) and antibiotics (53.97%) are the most common medicines used for self-medication. Most pharmacy students have good knowledge (87.38%) and a positive attitude (96.03%) toward responsible self-medication. However, only 27.34% of students practice rational self-medication. Participants' university and parents' professions were significantly associated with good knowledge of responsible self-medication. Whereas factors such as gender, residence, and type of illness were significantly associated with rational self-medication practice. CONCLUSION: The prevalence of self-medication was high among pharmacy students in Uganda. Painkillers and antibiotics are the most preferred drugs for self-medication. About 87.38% of pharmacy students have good knowledge, and 96.03% have a positive attitude toward responsible self-medication. Rational self-medication practice was low among students. We recommended training sessions to enhance safe self-medication practices among pharmacy students.
Acute Niclofolan Intoxication Led to Stillbirth: A Case Report.
Li RF, Wang LF, Zhang HY … +1 more , He MJ
Drug Healthc Patient Saf · 2025 · PMID 39802747 · Full text
Niclofolan is a commonly used veterinary drug worldwide. We reported a case of acute niclofolan intoxication in a pregnant woman. We recorded in detail her toxic symptoms, including nausea, vomiting, asthenia, blurred vi...
Niclofolan is a commonly used veterinary drug worldwide. We reported a case of acute niclofolan intoxication in a pregnant woman. We recorded in detail her toxic symptoms, including nausea, vomiting, asthenia, blurred vision, and aberrant blood values. Notably stillbirth was recorded for the first time as indicating its human reproductive toxicity. We also found that an oral therapeutic dosage as described in the literature was likely to lead to stillbirth. Furthermore, we described the treatments received by the patient, including critical care, drug therapy, and plasma exchange, the outcomes of which were excellent. By studying this case, we aimed to enhance recognition and treatment of niclofolan intoxication and to raise concern regarding veterinary drug abuse and exposure risk.
A Cross-Sectional Evaluation of Opioid Dispensing Competencies in Final-Year Pharm-D Students: A Multicenter Study from Punjab, Pakistan.
Mubarak N, Rahman Rana F, Zahid T … +12 more , Ijaz UE, Shabbir A, Ghulam Bari A, Niaz B, Kanwal S, Saif-Ur-Rahman N, Iqbal Z, Khan AM, Zin CS, Mahmood K, Elnaem MH, Tariq S
Drug Healthc Patient Saf · 2024 · PMID 39749185 · Full text
BACKGROUND: The opioid crisis continues to be a public health concern worldwide due to the high rates of misuse and associated mortality. Opioid dispensing competencies are critical for pharmacy graduates to promote the...
BACKGROUND: The opioid crisis continues to be a public health concern worldwide due to the high rates of misuse and associated mortality. Opioid dispensing competencies are critical for pharmacy graduates to promote the rational use of opioids. PURPOSE: To evaluate the opioids dispensing competencies among the final year Pharm-D students in Punjab, Pakistan. DESIGN: A multicenter cross-sectional study. METHODS: A validated survey was used to evaluate 11 competencies related to opioid use from the final year Pharm-D students from diversely located accredited institutes. On a summative scale, correct response to each survey item was worth a score/point. Descriptive statistics was used for categorical variables while independent -test computed group differences. RESULTS: A total of n = 661 final year Pharm-D students from 28 institutes (8 public and 20 private) completed the survey with an overall response rate of 78.5%. Comparatively, the students who had either completed a community or hospital internship, or studying in the educational institutions located in the provincial capital demonstrated a significant higher competency score. There was no significant difference in the overall mean competency scores based on gender or system of assessment used in the Pharm-D degree programs. Among eleven opioid competencies, students received the lowest scores for "opioid overdose management", "opioid monitoring" and "therapeutic uses of opioids". CONCLUSION: Pharm-D students in Pakistan require additional training and skills on many of the opioids related competencies to ensure patient's safety in healthcare settings. There is a need to revise the curriculum and teaching methodologies to improve the competencies of Pharm-D students in opioid dispensing.
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