Clinical Pharmacy[JOURNAL]
Sun
200 papers
Correction: Impact of an AI-powered hospital admission prediction dashboard to guide medication reconciliation in the emergency department: a retrospective before-after study.
Maathuis J, Veldhuis A, Egbers JB … +5 more , Geerdink J, Karapinar-Çarkit F, van den Bemt PMLA, Hulshof EC, Kingma JS
Int J Clin Pharm · 2026 Jun · PMID 41627662 · Full text
Abstract loading — click title to view on PubMed.
Exploring the effects of renal and cardiac functions on the pharmacokinetics of vancomycin in patients undergoing cardiac surgery: a population pharmacokinetic analysis.
Ding Y, Xue L, Qin Q … +7 more , Huang H, Chen Y, Shen H, Hu Y, Chen Y, Miao L, Shen Z
Int J Clin Pharm · 2026 Jun · PMID 41563694 · Full text
INTRODUCTION: Vancomycin is a glycopeptide antibiotic commonly prescribed to treat severe gram-positive infections; however, it has a narrow therapeutic range and potentially induces nephrotoxicity following overdosing....
INTRODUCTION: Vancomycin is a glycopeptide antibiotic commonly prescribed to treat severe gram-positive infections; however, it has a narrow therapeutic range and potentially induces nephrotoxicity following overdosing. Most studies have revealed that renal function is the main factor influencing vancomycin clearance. However, the effects of cardiac insufficiency, which usually occurs early following surgery and can cause changes in the pharmacokinetics of various drugs, likely due to decreased cardiac output, on vancomycin metabolism are poorly understood. AIM: This study aimed to establish a vancomycin population pharmacokinetic model in patients undergoing cardiac surgery and simultaneously explore the effects of renal and cardiac functions on vancomycin pharmacokinetics. METHOD: Three hundred twenty patients treated with vancomycin were enrolled. The patients' vancomycin treatment history, specific vancomycin administration and sampling times, and laboratory test results were obtained from the electronic medical records. The data were analyzed using nonlinear mixed effects modeling. Model accuracy and robustness were evaluated with a goodness-of-fit plot, bootstrap resampling, and visual predictive checks. The vancomycin dosage strategy was simulated with a virtual patient using the pharmacokinetic parameters of the established model in different clinical scenarios. RESULTS: A one-compartment model was used to determine vancomycin pharmacokinetics. The estimated clearance (CL) and distribution volume (V) of vancomycin were 3.22 L/h and 88.3 L, respectively. The interindividual variabilities in CL and V were 26.0% and 48.9%, respectively, while the corresponding interoccasion variabilities were 8.9% and 13.6%. CL decreased as serum creatinine (Scr), cystatin C (CysC) and N-terminal pro-B-type natriuretic peptide levels increased. V decreased as the CysC levels and neutrophil counts increased but increased with age. The highest percentage of the within 24-h target area under the concentration curve (400-650 mg*h/L) for the virtual patient across the different clinical scenarios was 52.4-65.2%. CONCLUSION: A vancomycin population pharmacokinetic model was established for cardiac surgery patients. Both renal and cardiac functions have confirmed effects on vancomycin pharmacokinetics.
Perspectives on potential pharmacist prescribing in an outpatient dialysis center: qualitative interviews with patients and clinicians.
Choi AS, Theodorlis M, Abbaticchio A … +1 more , Battistella M
Int J Clin Pharm · 2026 Jun · PMID 41546799 · Full text
INTRODUCTION: Pharmacist prescribing is expanding across care settings, supported by pharmacists' expertise in pharmacology, therapeutics, disease management, and medication optimization. In settings where pharmacists ca...
INTRODUCTION: Pharmacist prescribing is expanding across care settings, supported by pharmacists' expertise in pharmacology, therapeutics, disease management, and medication optimization. In settings where pharmacists can prescribe, patients and providers report positive outcomes. However, limited research has examined pharmacist prescribing in dialysis centers. AIM: This study explored patient and clinician perspectives on potential pharmacist prescribing in the outpatient hemodialysis unit at Toronto General Hospital, University Health Network (TGH-UHN) in Toronto, Canada. METHOD: Semi-structured, one-on-one interviews were conducted with English-speaking adults receiving hemodialysis, and clinicians, including nephrologists, pharmacists, dietitians, and nurse practitioners in the outpatient hemodialysis unit at TGH-UHN. Patient interviews focused on experiences receiving and filling prescriptions, interactions with pharmacists in the hemodialysis unit, and views on potential pharmacist prescribing in the unit. Clinician interviews explored the strengths and limitations of the current prescribing process in the hemodialysis unit, pharmacists' role in the unit, perceived benefits and challenges of potential pharmacist prescribing, and strategies for implementation. Participants were recruited through convenience sampling until data saturation was reached. Interviews were audio-recorded, transcribed, and analyzed thematically using an inductive approach. RESULTS: Eleven patients and 11 clinicians (six nephrologists, two pharmacists, two dietitians, and one nurse practitioner) were interviewed in June and July 2025. Reported challenges of the current prescribing process included communication gaps and delays in care, while accessibility of prescribers and interdisciplinary collaboration were identified as strengths. Pharmacists were recognized as valuable care team members for their expertise in medication management and rapport with patients. Anticipated benefits of pharmacist prescribing included improved medication optimization, workflow efficiency, timely care, and pharmaco-economic savings. Limited prescribing knowledge among some pharmacists was noted as a barrier. Implementation considerations included a collaborative approach, maintaining physician oversight, restricting prescribing to specific clinical areas, phased rollout, patient and clinician buy-in, adequate resources, and clearly defined roles and communication. CONCLUSION: Patients and clinicians were generally supportive of potential pharmacist prescribing in the hemodialysis unit, contingent on several considerations for implementation. Interviews with additional stakeholders in other dialysis care settings could further inform strategies for broader adoption.
Behavioural determinants influencing continuing professional development in healthcare practice: a qualitative study.
Al-Omary H, Soltani A, Stewart D … +1 more , Nazar Z
Int J Clin Pharm · 2026 Jun · PMID 41543790 · Full text
INTRODUCTION: The integration of learning from continuing professional development (CPD) activities into practice is shaped by behavioral, organizational, and broader system-level factors. However, there is scarce resear...
INTRODUCTION: The integration of learning from continuing professional development (CPD) activities into practice is shaped by behavioral, organizational, and broader system-level factors. However, there is scarce research utilizing theory to provide a comprehensive understanding of prevalent behavioral determinants. AIM: To investigate key behavioral determinants that influence CPD participants' implementation of learning into their practice following participation in CPD activities. METHOD: Eleven semi-structured interviews were conducted with healthcare professionals 4-6 weeks after they participated in a live, interactive CPD workshop. Interview questions were guided by the COM-B model to elucidate behavioral determinants; emerging themes were subsequently mapped to the COM-B domains. Recommended interventions were derived to optimize CPD outcomes using the Behavior Change Wheel (BCW). RESULTS: All participants (n = 11) reported applying their CPD learning in practice, either partially or fully). Analysis revealed that while Capability, Opportunity, and Motivation were all perceived to influence implementation, Motivation was an important driver, with professional responsibility and satisfaction from positive patient outcomes were also perceived to influence behavior. Opportunity was particularly challenging in community pharmacy settings due to time constraints, workload, and organizational factors. These findings informed targeted recommendations to optimize CPD implementation. CONCLUSION: This study highlights the complex interplay of behavioral determinants that are perceived to influence the translation of CPD learning into routine clinical practice. Effective CPD programs should incorporate strategies to address setting-specific barriers-such as time constraints, emotional pressures, and organizational support to foster motivation and facilitate sustained practice change. Tailoring CPD design to these behavioral determinants can improve the integration of learning into practice and ultimately enhance patient care.
Venous thromboembolism prophylaxis in adults hospitalised for psychiatric illness: an evidence-based clinical practice guideline developed using GRADE.
Purcell A, Ní Áinle F, Hunt BJ … +13 more , Delluc A, Roberts L, Jenkinson J, Hoblyn J, Keating D, Carolan A, Roche E, Morgan K, Duffy R, Garvey S, Flood J, O Neill AM, Agarwal A
Int J Clin Pharm · 2026 Jun · PMID 41543789 · Full text
INTRODUCTION: Venous thromboembolism (VTE) is the leading cause of preventable hospital deaths. Adults hospitalised with psychiatric illness vary in their risk of VTE, and therefore in their likelihood of benefiting from...
INTRODUCTION: Venous thromboembolism (VTE) is the leading cause of preventable hospital deaths. Adults hospitalised with psychiatric illness vary in their risk of VTE, and therefore in their likelihood of benefiting from thromboprophylaxis. There is a paucity of evidence-based practice guidelines addressing VTE prophylaxis for this population despite recognition of additional VTE risk factors in this population. AIM: To develop an evidence-based guideline on VTE prophylaxis for patients hospitalised with psychiatric illness using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). METHOD: An international, multidisciplinary, guideline panel including clinical experts, methodologists, and a patient partner was recruited by invitation. Panelists were selected based on methodological and clinical expertise on this subject. Panel members were diverse in geography (from Ireland, the United Kingdom, France, and Canada), expertise and gender. The panel was composed of four advanced specialist psychiatric pharmacists, four consultant haematologists, four consultant psychiatrists, one advanced nurse practitioner in psychiatry, one advanced nurse practitioner in anticoagulation, a methodologist with expertise using GRADE, and a patient partner with lived experience of VTE. The panel prioritised two clinical questions and related population, interventions, outcomes, and secondary analyses according to their importance for patients. GRADE was used to assess certainty of evidence and to move from evidence to risk-stratified recommendations. RESULTS: The panel made three recommendations: a strong recommendation against parenteral pharmacological prophylaxis for patients at low risk of VTE (moderate-certainty evidence); a conditional recommendation in favour of parenteral pharmacological prophylaxis in high-risk patients (low-certainty evidence); and a strong recommendation against graduated compression stockings in patients at high risk of VTE with a contraindication to parenteral pharmacological prophylaxis (low-certainty evidence). CONCLUSION: Clinicians should not use parenteral pharmacological prophylaxis in adults hospitalised with psychiatric illness at low risk of VTE; and should consider using parenteral pharmacological prophylaxis for high-risk adults with no contraindications. Graduated compression stockings are not recommended in high-risk patients when parenteral pharmacological prophylaxis is contraindicated. These GRADE- based recommendations offer one of the first evidence-based practice guidelines for thromboprophylaxis decisions in psychiatric in-patient settings.
Patient perspectives on drug recalls in the Netherlands: a qualitative study.
Annema PA, Venrooij LMWN, Bouvy ML … +2 more , van Marum RJ, Derijks HJ
Int J Clin Pharm · 2026 Jun · PMID 41533231 · Full text
INTRODUCTION: Drug recalls occur regularly with some resulting in medication switches for patients. Limited research into this topic suggests that drug recalls can lead to anxiety and unrest for patients which in turn ca...
INTRODUCTION: Drug recalls occur regularly with some resulting in medication switches for patients. Limited research into this topic suggests that drug recalls can lead to anxiety and unrest for patients which in turn can affect confidence in and use of medication. In this context, a better understanding of patient perceptions and communication preferences is essential to adequately handle drug recalls and ensure continued medication adherence and trust. AIM: The aim of this study was to elucidate patients' experiences, perceptions, and preferences regarding drug recalls. METHOD: This qualitative study comprised focus group discussions with patients that experienced a drug recall, recruited through pharmacies from distinct locations in the Netherlands. We aimed to conduct at least two focus groups, each comprising a minimum of six participants. Audio recordings were transcribed verbatim and analyzed using a thematic analysis approach. RESULTS: It was found that patients had limited knowledge of drug recall procedures, often confused them with shortages, and struggled to interpret associated risks. Communication was frequently perceived as unclear, triggering varied emotional responses and, in some cases, reduced trust in and use of medications. Patients preferred pharmacist-led, personalized communication tailored to recall urgency, and emphasized the importance of shared decision-making, particularly during medication substitutions. CONCLUSION: Drug recalls cause a range of emotions in patients, leading to reduced confidence and use of medication in some patients. Preferences centered on understandable, transparent, and personalized communication led by pharmacists. The findings of this study emphasize the importance of embedding patient engagement and tailored communication within pharmacovigilance systems to maintain trust and support shared decision-making during drug recalls.
Fixed dose versus 3-day loading dose warfarin initiation in atrial fibrillation: effects on INR stabilization and time in the therapeutic range.
Syed Hamzah SN, Soelar SA, Harun SN
Int J Clin Pharm · 2026 Jun · PMID 41528716 · Full text
INTRODUCTION: Warfarin initiation strategies vary, with some clinicians using either a fixed-dose or loading-dose regimen to achieve therapeutic anticoagulation. However, evidence comparing their effectiveness in multiet...
INTRODUCTION: Warfarin initiation strategies vary, with some clinicians using either a fixed-dose or loading-dose regimen to achieve therapeutic anticoagulation. However, evidence comparing their effectiveness in multiethnic Asian populations without genotype-guided dosing remains limited. AIM: To compare a fixed-dose regimen with a 3-day loading-dose regimen in terms of international normalized ratio (INR) stability and time in the therapeutic range (TTR) over 12 months in a multiethnic atrial fibrillation (AF) cohort. We also aimed to evaluate the relationship between the time to initial INR stabilization and the subsequent anticoagulation quality. METHOD: This multicenter, retrospective cohort study included 780 warfarin-naïve patients with AF from two tertiary hospitals (2010 to 2022). Patients were grouped by the initiation strategy: fixed-dose (n = 501) or 3-day loading-dose (n = 279). The primary outcome was the TTR at 3, 6, and 12 months. The association between time to INR stabilization and TTR was assessed using Spearman's correlation, and a General Linear Model (GLM) was used to adjust for comprehensive demographic and clinical confounders. RESULTS: The time to initial INR stabilization showed a strong inverse correlation with TTR across all time points (Spearman's r = -0.600 to -0.710; p < 0.001). Although the unadjusted analysis suggested that the INR stabilized faster in the loading-dose group (mean: 111.8 vs. 138.6 days; p < 0.001), this difference became insignificant after accounting for confounding factors (adjusted mean: 94.1 vs 104.1 days; p = 0.248). Similarly, adjusted means of TTRs did not differ significantly between regimens at 3, 6, or 12 months. CONCLUSION: The choice between fixed-dose and loading-dose warfarin initiation strategies does not independently influence long-term anticoagulation control. Instead, time to initial INR stabilization is the strongest predictor of TTR quality over 12 months. Clinical efforts should prioritize early and intensive INR monitoring in settings without genotype-guided dosing, as both baseline characteristics and the ongoing clinical management likely determine anticoagulation outcomes.
Advancing pharmacist involvement in surgical prehabilitation: a call to action for global pharmacy practice.
Wang Y, Lu J, Wu J … +19 more , Wang R, Wei L, Li Y, Zeng Y, Li X, Chen J, Ji B, Liu T, Wu H, Wang J, Mai H, Zheng P, Yu S, Chen P, Yang C, Yu P, Mo X, Chen Y, Zheng Z
Int J Clin Pharm · 2026 Apr · PMID 41493755 · Full text
Prehabilitation has emerged as a proactive, multimodal strategy in perioperative care, aiming to enhance functional capacity and resilience before surgery through medical optimization, exercise, nutrition, and psychologi...
Prehabilitation has emerged as a proactive, multimodal strategy in perioperative care, aiming to enhance functional capacity and resilience before surgery through medical optimization, exercise, nutrition, and psychological support. Despite their multidisciplinary nature, pharmacists are underutilized in this evolving field. Pharmacists are uniquely positioned to advance prehabilitation by applying Medication Therapy Management (MTM) and Collaborative Drug Therapy Management (CDTM) models to identify medication-related risks, manage comorbidities, and optimize perioperative outcomes. China's experience provides a compelling demonstration of this potential. Since 2015, Zhihua Zheng and colleagues at the Guangdong Pharmaceutical Association have pioneered surgical pharmacy, integrating MTM into pharmacist-managed clinics and employing CDTM frameworks to extend pharmacists' clinical authority in China. These innovations empower pharmacists to perform key prehabilitation functions, such as optimizing complex medication regimens, mitigating polypharmacy, stabilizing cardiovascular and metabolic parameters, managing nutrition and anemia, and supporting pain control. Internationally, prehabilitation has gained traction through initiatives such as Enhanced Recovery After Surgery programs and perioperative surgical home models. However, the pharmacist's contribution remains insufficiently defined. This commentary aims to highlight strategic opportunities for strengthening pharmacist involvement in prehabilitation rather than prescribing detailed operational protocols. Integrating MTM and CDTM conceptually within prehabilitation teams offers a scalable, evidence-informed direction that can guide health systems to enhance perioperative safety and readiness. Pharmacist-led interventions not only reduce medication errors and adverse events but also complement the work of surgeons, anesthesiologists, nutritionists, and rehabilitation specialists. Global collaboration is essential for standardizing competencies, developing training frameworks, and strengthening the evidence for pharmacist-led prehabilitation. The International Pharmaceutical Federation (FIP), the American Society of Health-System Pharmacists (ASHP), and the European Society of Clinical Pharmacy can catalyze this progress by promoting education, guidelines, and policy integration. By embedding MTM/CDTM into surgical prehabilitation, health systems can empower pharmacists to enhance patient safety, improve surgical outcomes, and advance the global standards of perioperative care.
Impact of an AI-powered hospital admission prediction dashboard to guide medication reconciliation in the emergency department: a retrospective before-after study.
Maathuis J, Veldhuis A, Egbers JB … +5 more , Geerdink J, Karapinar-Çarkit F, van den Bemt PMLA, Hulshof EC, Kingma JS
Int J Clin Pharm · 2026 Jun · PMID 41483296 · Publisher ↗
INTRODUCTION: Medication reconciliation (MR) in the emergency department (ED) is essential to ensure medication safety, especially for patients admitted to the hospital. However, performing MR for all ED patients, includ...
INTRODUCTION: Medication reconciliation (MR) in the emergency department (ED) is essential to ensure medication safety, especially for patients admitted to the hospital. However, performing MR for all ED patients, including those discharged, can be inefficient. To optimize prioritization, an artificial intelligence (AI)-powered hospital admission prediction dashboard was introduced. AIM: The primary aim of this study was to evaluate the effect of an artificial intelligence (AI) powered hospital admission prediction dashboard on the proportion of patients admitted to the hospital with an MR performed in the ED. The secondary aim was to assess its effect on the proportion of patients discharged from the ED with an MR. METHOD: This retrospective before-after study was conducted at Hospital Group Twente and included ED visits between March 15 and December 31 in both 2023 and 2024. In the pre-intervention period, MR was strived for any patient, including patients discharged directly from the ED (i.e. potentially unnecessary MR as the risk for errors is low) and for admitted patients (i.e. correct MR). In 2024, the post-intervention period, a set of Extreme Gradient Boosting (XGBoost) models was trained on historical data (2015-2022) and integrated into a real-time dashboard to prioritize patients with the highest admission probability to perform MR. Primary outcome was the proportion of patients with correct MR. Secondary outcome was the proportion of patients with a potentially unnecessary MR. Chi-square test was used to compare proportions before and after implementation of the dashboard. RESULTS: The study included 25,505 ED visits. Pre-intervention 12,743 ED visits were included with 5,252 MRs performed. Post-intervention 12,762 ED visits were included with 4,882 MRs. After implementing the dashboard, the proportion of patients with correct MR increased from 86.4 to 89.0% (p = 0.0002), and the proportion of patients with potentially unnecessary MR decreased from 17.9 to 12.6% (p < 0.0001). CONCLUSION: The AI-powered hospital admission prediction dashboard improved the prioritization of MR in the ED. The proportion of patients with potentially unnecessary MR remains substantial and requires further improvement.
Correction: Pharmacist input to depression screening and management in patients with diabetes: a systematic review.
Al-Hawamdeh MI, Al Raisi F, Al-Aladawi RM … +2 more , Abu-Huwaij R, Tonna AP
Int J Clin Pharm · 2026 Apr · PMID 41420683 · Full text
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Sodium-glucose cotransporter-2 inhibitors and risk of diabetic retinopathy in type 2 diabetes: a network meta-analysis of randomised clinical trials.
Ortiz-Seller A, Ortiz-Seller D, Morcillo E … +1 more , Ortiz JL
Int J Clin Pharm · 2026 Feb · PMID 41417177 · Publisher ↗
INTRODUCTION: Sodium-glucose cotransporter‑2 (SGLT‑2) inhibitors are widely used in type 2 diabetes, but their effect on the incidence of diabetic retinopathy remains uncertain. AIM: To update the evidence on the relatio...
INTRODUCTION: Sodium-glucose cotransporter‑2 (SGLT‑2) inhibitors are widely used in type 2 diabetes, but their effect on the incidence of diabetic retinopathy remains uncertain. AIM: To update the evidence on the relationship between SGLT-2 inhibitors and diabetic retinopathy incidence using a Bayesian network meta‑analysis (NMA) of randomised controlled trials (RCTs). METHOD: A systematic search on Embase, PubMed, Web of Science, and ClinicalTrials.gov to 25 August 2025 identified RCTs in adults with type 2 diabetes comparing an SGLT‑2 inhibitor with placebo or active comparators and reporting diabetic retinopathy outcomes. A random‑effects Bayesian NMA estimated odds ratios (ORs) with 95% credible intervals (CrI) with ranking based on the surface under the cumulative ranking curve (SUCRA). Evidence quality was assessed using the Cochrane Risk-of-Bias tool and Confidence in Network Meta-Analysis (CINeMA). Network meta-regression explored treatment‑by‑covariate interactions including baseline diabetic retinopathy risk. Model‑based NMA (MBNMAdose) evaluated dose-response patterns. RESULTS: Thirty RCTs (eight gliflozins; 70,310 participants across study arms) formed a star‑shaped network without head‑to‑head trials. CINeMA indicated low confidence for most comparisons, mainly due to imprecision, with some concerns about indirectness and generally no concerns regarding heterogeneity or incoherence. No SGLT‑2 inhibitor altered diabetic retinopathy risk versus placebo (all 95% CrIs included 1.0). Probability rankings suggested empagliflozin most likely to be favourable and luseogliflozin least favourable (SUCRA values of 85.88% and 22.96%, respetively), but between‑drug differences were not statistically significant. Network meta‑regression identified effect modification by baseline diabetic retinopathy risk: higher placebo event rates were associated with lower relative odds under SGLT‑2 inhibition. No dose-response signal for diabetic retinopathy was detected, in contrast to dose‑related improvements in HbA1c and reductions in body weight and blood pressure. CONCLUSION: SGLT‑2 inhibitors showed a neutral effect on the incidence of diabetic retinopathy. Baseline diabetic retinopathy risk appears to moderate relative effects, and no dose-response was evident for diabetic retinopathy. Choice among agents should be driven by overall efficacy, safety and patient factors rather than retinal risk; dedicated trials with prespecified ophthalmic endpoints are warranted.
Beyond existing rating scales: development of a novel nomogram for predicting severe clinical bleeding associated with low-molecular-weight heparin in hospitalized medical patients.
Fu Z, Zhan X, He M … +11 more , Dong Z, Fang Y, Zhang X, Zhou T, Jin B, Zhu D, Gu J, Zhou Y, Chen Y, Xie M, Yuan H
Int J Clin Pharm · 2026 Jun · PMID 41396562 · Full text
INTRODUCTION: Low-molecular-weight heparin (LMWH) is widely used for thromboprophylaxis and treatment in hospitalized patients; however, LMWH-related severe clinical bleeding (LSCB) remains a major concern. Existing risk...
INTRODUCTION: Low-molecular-weight heparin (LMWH) is widely used for thromboprophylaxis and treatment in hospitalized patients; however, LMWH-related severe clinical bleeding (LSCB) remains a major concern. Existing risk scales have been developed for oral anticoagulants and have limited applicability to LMWH, leaving clinicians without reliable bedside tool. AIM: This study aimed to evaluate the discriminatory performance of existing scales for predicting LSCB and develop a tailored nomogram for individualized risk prediction. METHOD: Hospitalized medical patients prescribed LMWH between July 2021 and August 2024 at three tertiary hospitals in Hangzhou, China were retrospectively analyzed. Each LSCB case was matched with three non-LSCB controls from the same department and period. The prevalence of LSCBs, bleeding sites, and clinical characteristics are described. Receiver operating characteristic (ROC) curves were used to assess the predictive performance of existing scales. Variables with p < 0.10 in univariate analysis were entered into logistic regression, a backward stepwise elimination (stay p < 0.05) was applied to identify independent predictors and subsequently incorporated into a nomogram. Discrimination, calibration, and external validation were performed. RESULTS: Among 22,096 patients, 369 (1.67%) developed LSCB, most commonly severe gastrointestinal bleeding (74.3%), with a mean onset of 5.68 days. A total of 1,089 patients with non-LSCB were matched as controls. Existing scales performed limited predictive value (AUC 0.52-0.68). Logistic regression identified 12 independent predictors: hypoproteinemia (albumin < 30 g/L), anemia (Hb < 90 g/L), active gastrointestinal ulcer, thrombocytopenia (platelets < 75 × 10⁹/L), coagulation abnormalities (PT or aPTT > 1.2 × ULN), cefoperazone/latamoxef exposure > 7 days, hypocalcemia ([Ca⁺] < 2.10 mmol/L), aspirin therapy, dual antiplatelet therapy, renal dysfunction (GFR < 60 mL/min), hepatic impairment (AST or ALT ≥ 3 or TBIL ≥ 2 × ULN), and age > 65 years. Odds ratios ranged from 6.16 (hypoproteinemia) to 1.47 (age > 65 years). A nomogram, named LSCB-Score, incorporating these factors achieved AUC 0.890 in the derivation cohort. Calibration was good (Hosmer-Lemeshow p = 0.312), and predictions closely matched the observations. External validation yielded an AUC of 0.876, confirming robustness. CONCLUSION: The existing scales for predicting LSCB lack accuracy in hospitalized patients. This newly developed nomogram (LSCB-Score) provides a practical framework for individualized bleeding risk assessment and facilitates safe management of LMWH in hospitals.
Risk factor analysis of hypertonic saline non-responders for the treatment of cerebral edema: a retrospective cohort study.
Feininger ES, May CC, Hinduja A … +2 more , McLaughlin E, Counts JP
Int J Clin Pharm · 2026 Feb · PMID 41379290 · Publisher ↗
INTRODUCTION: First line treatment of cerebral edema or elevated intracranial pressure involves hyperosmolar therapy. AIM: The purpose of this study was to identify risk factors associated with hypertonic saline solution...
INTRODUCTION: First line treatment of cerebral edema or elevated intracranial pressure involves hyperosmolar therapy. AIM: The purpose of this study was to identify risk factors associated with hypertonic saline solutions (HTS) non-responders post HTS bolus for treatment of cerebral edema. METHOD: This single center, retrospective cohort study included neurocritical care patients who received one bolus dose of 3% NaCl (> 100 mL) or 23.4% NaCl (30 mL) and obtained one serum sodium level between one and eight hours after administration. The primary outcome was to determine the incidence of HTS non-responders, defined as a serum sodium response of < 5 mEq/L on repeat lab draw, and to identify risk factors associated with HTS non-response (sodium < 5 mEq/L) within 8 h after a HTS bolus dose. RESULTS: A total of 200 patients were included. The primary neurologic injuries included were acute ischemic stroke (41.5%) and intracerebral hemorrhage (35.5%). For the primary outcome, 127 (63.5%) patients were HTS non-responders. Risk factors associated with HTS non-response, included patients who did not receive mannitol prior to HTS (OR 3.31, 95% CI 1.34-8.17; p = 0.009), male sex (OR 2.43; 95% CI 1.27-4.63; p = 0.007), and patients without intraventricular hemorrhage (IVH) (OR 2.12; 95% CI 1.11-4.06; p = 0.024). CONCLUSION: Overall, 63.5% patients were non-responders to HTS. Risk factors for non-response to HTS included no prior mannitol therapy, male sex, and patients without IVH. Further studies are warranted to assess the impact these risk factors have on HTS dosing and the treatment of cerebral edema.
Adherence to biologics in patients with inflammatory bowel disease: a systematic review and meta-analysis.
Pan W, Tian W, Li S … +4 more , Zhao Y, Liu Y, He Y, Feng X
Int J Clin Pharm · 2026 Feb · PMID 41369787 · Publisher ↗
INTRODUCTION: Adherence to biologics is crucial for the effective management of patients with inflammatory bowel disease (IBD). However, comprehensive data on the prevalence of adherence is still lacking. AIM: This syste...
INTRODUCTION: Adherence to biologics is crucial for the effective management of patients with inflammatory bowel disease (IBD). However, comprehensive data on the prevalence of adherence is still lacking. AIM: This systematic review and meta-analysis aimed to estimate the prevalence of adherence to biologics among adult patients with IBD and to identify the factors influencing adherence. METHOD: We conducted a systematic search of PubMed, Embase, Scopus, CINAHL, Web of Science, the Cochrane Library, and three Chinese databases for relevant observational studies published between January 1, 2010, and March 15, 2025. A random-effects model was employed to calculate the pooled prevalence of adherence. Heterogeneity and publication bias were assessed. We classified the identified influencing factors and conducted a narrative synthesis to summarize the findings. RESULTS: This review included 29 studies involving 44,397 patients with IBD from 14 countries. The pooled prevalence of adherence to biologics was 70% (95% CI 66%-75%, I = 98.9%). Subgroup analyses indicated that higher adherence was likely among patients from upper-middle-income countries, those assessed with validated subjective tools, patients with CD, and those receiving subcutaneous biologics. Studies with cross-sectional designs and lower methodological quality also tended to report higher adherence. Gender and insurance status were identified as key factors influencing adherence, consistently supported by at least three studies. CONCLUSION: The results suggested that adult patients with IBD exhibit moderately high levels of adherence to biologics. Gender and insurance status were factors associated with adherence. Given that these conclusions are limited by heterogeneity and methodological diversity, further validation through high-quality studies is required.
Exploring pharmacist prescribing practices in general practices for atrial fibrillation in England: a qualitative study using the theoretical domains framework.
Sharma R, Hasan SS, Conway BR … +1 more , Ghori MU
Int J Clin Pharm · 2026 Jun · PMID 41369786 · Full text
INTRODUCTION: Pharmacist roles in primary care are evolving, with increasing involvement in long-term condition management. An example is their crucial role in the management of atrial fibrillation (AF), particularly in...
INTRODUCTION: Pharmacist roles in primary care are evolving, with increasing involvement in long-term condition management. An example is their crucial role in the management of atrial fibrillation (AF), particularly in prescribing and monitoring oral anticoagulation therapy. However, their experiences and challenges in this area remain underexplored, particularly within the context of general practice. AIM: This study aimed to explore the experiences, perceptions, and challenges of independent prescribing pharmacists when managing and prescribing for AF within general practice, using the Theoretical Domains Framework (TDF) to guide enquiry and analysis. METHOD: We conducted a qualitative study underpinned by the Theoretical Domains Framework (TDF), which informed both the interview guide and the analytic coding framework. Independent prescribing pharmacists working in general practice in England were purposively recruited via professional networks; eligible participants were patient-facing and had experience prescribing for atrial fibrillation. One-to-one, semi-structured interviews were conducted via Microsoft Teams® in August 2024, audio-recorded, transcribed verbatim, and returned to participants for checking. Recruitment proceeded until thematic saturation. Two researchers independently applied the framework method, resolved discrepancies by consensus, and mapped final themes to relevant TDF domains. RESULTS: Twenty pharmacists took part in the study (9 men, 11 women; age 25-52 years), providing perspectives from a range of experience levels. Four overarching themes emerged: (1) confidence and experience in prescribing, (2) perceived role and responsibilities, (3) barriers to effective prescribing, and (4) strategies for effective prescribing. Pharmacists with extensive AF experience demonstrated higher confidence, whereas less experienced pharmacists relied on guidelines and colleagues. Perceived roles ranged from central to supportive within multidisciplinary teams, with some uncertainty about role boundaries. Key barriers included incomplete access to patient records, limited training, and workload pressures. Strategies to support prescribing included continuous professional development, decision support tools, and peer consultation. CONCLUSION: The study emphasises the challenges pharmacists encounter in managing AF, highlighting the need for clearer role definitions, improved access to patient data and ongoing peer support. Addressing the identified barriers through targeted interventions could enhance the effectiveness of pharmacist-led AF management in general practice. Future research should evaluate interventions designed to support pharmacists in this evolving role.
Long-term safety, effectiveness, and cost of rapamycin- vs. everolimus-eluting stents in acute coronary syndrome: a real-world cohort study.
Lin X, Wang Y, Tan S … +6 more , Kuang C, Huang Y, Zhao J, Yao J, Cao S, Zhang J
Int J Clin Pharm · 2026 Feb · PMID 41369785 · Publisher ↗
INTRODUCTION: Drug-eluting stents are the cornerstone of treatment in patients with Acute Coronary Syndrome (ACS) undergoing Percutaneous Coronary Intervention (PCI). However, long-term comparative data on rapamycin-elut...
INTRODUCTION: Drug-eluting stents are the cornerstone of treatment in patients with Acute Coronary Syndrome (ACS) undergoing Percutaneous Coronary Intervention (PCI). However, long-term comparative data on rapamycin-eluting and everolimus-eluting stents remain limited. AIM: This study aimed to evaluate the long-term (5-7 years) safety, effectiveness, and cost profiles of rapamycin-eluting stents versus everolimus-eluting stents in patients with ACS following PCI. METHOD: This was a prospective, single-center cohort study. Consecutive patients with ACS who underwent PCI with either rapamycin-eluting stents or everolimus-eluting stents between October 2018 and October 2019 were enrolled and followed-up from November 2024 to February 2025 via clinic visits or telephone interviews. The primary outcome was the incidence of overall adverse events (AEs). The secondary outcomes included all-cause mortality, readmission rate, EuroQol Visual Analog Scale (EQ-VAS) scores, treatment costs, out-of-pocket expenses, new-onset hypertension, diabetes, and hyperlipidemia. Potential predictors of AEs were first identified by univariate logistic regression (P < 0.1). Confounders, determined using Directed Acyclic Graphs (DAGs), were then adjusted for in a multivariable logistic regression model to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: In total, 120 patients (60 per group) were included. No significant association was found between stent type and overall AEs [27/60 (45.00%) vs. 25/60 (41.67%); adjusted odds ratio (OR) = 1.08, 95% CI 0.45-2.58; P = 0.87]. Although all-cause mortality [8/60 (13.33%) vs. 4/60 (6.67%); relative risk (RR) = 2.00, 95% CI 0.64-6.29; P = 0.24] and readmission rates [4/60 (6.67%) vs. 1/60 (1.67%); RR = 4.00, 95% CI: 0.45-35.27; P = 0.36] were higher in the rapamycin-eluting stent group, the differences were not statistically significant. EQ-VAS scores did not differ significantly between the groups (70.28 vs. 72.30; mean difference = - 2.02, 95% CI - 6.70 to 2.66; P = 0.42). However, the everolimus-eluting stent group had significantly higher treatment costs (¥58,853.38 RMB vs. ¥48,609.22 RMB; P = 0.00). CONCLUSION: Rapamycin-eluting stents demonstrated long-term safety and effectiveness comparable to everolimus-eluting stents in ACS patients post-PCI while offering a significant cost advantage. These findings suggest that rapamycin-eluting stents are potentially more cost-effective. For healthcare systems seeking to enhance value-based procurement, these results justify the preferential selection and wider adoption of rapamycin-eluting stents in clinical practice. However, confirmation through large-scale, multicenter, prospective studies is warranted.
Targeting pyroptosis in atherosclerosis: emerging pharmacologic strategies and natural compound-based therapeutics-a narrative review.
Liu Q, Shi Y, Qin L
Int J Clin Pharm · 2026 Feb · PMID 41369784 · Publisher ↗
INTRODUCTION: Atherosclerosis is the pathological foundation of most cardiovascular diseases and remains the leading cause of mortality worldwide. Increasing evidence shows that pyroptosis, a pro-inflammatory form of pro...
INTRODUCTION: Atherosclerosis is the pathological foundation of most cardiovascular diseases and remains the leading cause of mortality worldwide. Increasing evidence shows that pyroptosis, a pro-inflammatory form of programmed cell death mediated by inflammasome activation and gasdermin D (GSDMD)-mediated pore formation, plays a key role in vascular endothelial dysfunction, immune cell activation, and plaque destabilization. Understanding how pharmacological agents modulate pyroptotic signaling is crucial for identifying new therapeutic strategies for atherosclerosis prevention and treatment. AIM: This narrative review aims to summarize the current evidence on the mechanisms by which pyroptosis contributes to the initiation and progression of atherosclerosis and to explore pharmacological strategies, including natural and synthetic compounds that target pyroptotic pathways to exert anti-atherosclerotic effects. METHOD: A narrative literature review was conducted using PubMed, Web of Science, and Scopus, from database inception to September 2025. The search combined terms related to "pyroptosis," "atherosclerosis," "inflammasome," "gasdermin," "drug," and "natural compound." Studies reporting the mechanisms or pharmacologic modulation of pyroptosis in endothelial cells, macrophages, or vascular smooth muscle cells were included, and data were synthesized according to cell type and mechanism of drug action. RESULTS: Pyroptosis contributes to all the stages of atherosclerosis by promoting vascular inflammation, lipid accumulation, and plaque rupture. The NLRP3 inflammasome, caspase-1, and GSDMD are major pharmacological targets. Small-molecule inhibitors, such as MCC950 and VX-765, suppress inflammasome activation and cytokine release, thereby reducing plaque burden. Multiple natural compounds, including salidroside, salvianolic acids, puerarin, oxymatrine, and quercetin, exert protective effects through antioxidative and anti-inflammatory mechanisms that inhibit inflammasome activation and restore endothelial integrity. These findings suggest the feasibility of combining pyroptosis-targeting compounds with established antiatherosclerotic therapies. CONCLUSION: Targeting pyroptosis offers a promising pharmacological approach for mitigating vascular inflammation and stabilizing atherosclerotic plaques. Natural compounds with inflammasome-modulating activities serve as valuable chemical scaffolds for the development of novel therapeutics. Further pharmacokinetic, toxicological, and clinical studies are needed to translate these mechanistic insights into effective treatment strategies for patients with atherosclerotic cardiovascular disease.
Correction: ESCP best practice: development of the national methodology for the provision of clinical-pharmaceutical care and its implementation in the healthcare system of the Czech Republic.
Hartinger JM, Tašková I, Gregorová J … +2 more , Slanař O, Fialová D
Int J Clin Pharm · 2026 Feb · PMID 41348312 · Publisher ↗
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Correction: Research priorities of the European Society of Clinical Pharmacy (ESCP): a questionnaire-based study.
Okuyan B, Henman MC, Paudyal V … +10 more , Weidmann AE, Cadogan C, Hazen A, Fialová D, Wirth F, Lutters M, Pouls B, Nazar Z, Raisi FA, Stewart D
Int J Clin Pharm · 2026 Apr · PMID 41348311 · Full text
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Characteristics and outcomes of pharmacy-supported transitions of care interventions in emergency departments: a scoping review.
Alhmoud E, Elamin W, Barazi R … +3 more , Alkudsi Z, Zahrah F, Hadi MA
Int J Clin Pharm · 2026 Apr · PMID 41342989 · Full text
INTRODUCTION: Transitions of care (ToC) services are essential for maintaining care continuity. The complex and fast-paced nature of care and high patient turnover in emergency departments (EDs) create unique challenges...
INTRODUCTION: Transitions of care (ToC) services are essential for maintaining care continuity. The complex and fast-paced nature of care and high patient turnover in emergency departments (EDs) create unique challenges and opportunities for improving transitional care. Although the benefits of pharmacy-supported ToC interventions are established in non-ED settings, there is a lack of evidence exploring their characteristics and outcomes in EDs. AIM: We aimed to identify and present the available evidence regarding the characteristics and outcomes of pharmacy-supported ToC interventions beyond medication reconciliation, as the sole intervention, in EDs. METHOD: This review was conducted in accordance with the Joanna Briggs Institute methodology and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews guidelines. A literature search was performed across PubMed, Embase, CINAHL, Web of Science, and grey literature from their inception until 22/12/24. The search included terms related to pharmacy, transitional care, and EDs. Data was extracted using a custom tool adapted from the Template for Intervention Description and Replication checklist, which was used to assess the articles' compliance with the items. RESULTS: A total of 64 publications were included. Most studies (n = 58) enrolled adult patients, with 13 focusing on older adults. Most interventions were delivered by pharmacists in collaboration with other healthcare providers in 64% of studies. Interventions were most implemented post-discharge (54.7%), followed by arrival to the ED (42.2%). Around 90.6% of interventions included two or more activities, combining medication reconciliation, discharge planning, and follow-up care. Most studies focused on health utilization metrics (e.g., readmission rates) as their outcomes (28.8%). Positive effects were observed on medication safety, antibiotic stewardship, patient satisfaction, and resource use. However, pediatric populations and intrahospital transitions were underrepresented. CONCLUSION: This scoping review highlights the potential of pharmacist-supported transitional care interventions within EDs. The role of pharmacists in ToC interventions in emergency settings is evidently growing. Despite this, critical gaps persist in reporting and implementing these interventions. Future research is needed to systematically explore such initiatives and evaluate their implementation and long-term impact.
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