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Volume 13
Issue 6
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Pharmacy, Volume 13, Issue 6 (December 2025) – 26 articles

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21 pages, 1976 KB  
Review
Large Language Models for Drug-Related Adverse Events in Oncology Pharmacy: Detection, Grading, and Actioning
by Md Muntasir Zitu, Ashish Manne, Yuxi Zhu, Wasimul Bari Rahat and Samar Binkheder
Pharmacy 2025, 13(6), 176; https://doi.org/10.3390/pharmacy13060176 - 3 Dec 2025
Viewed by 159
Abstract
Preventable medication harm in oncology is often driven by drug-related adverse events (AEs) that trigger order changes such as holds, dose reductions, delays, rechallenges, and enhanced monitoring. Much of the evidence needed to make these decisions lives in unstructured clinical texts, where large [...] Read more.
Preventable medication harm in oncology is often driven by drug-related adverse events (AEs) that trigger order changes such as holds, dose reductions, delays, rechallenges, and enhanced monitoring. Much of the evidence needed to make these decisions lives in unstructured clinical texts, where large language models (LLMs), a type of artificial intelligence (AI), now offer extraction and reasoning capabilities. In this narrative review, we synthesize empirical studies evaluating LLMs and related NLP systems applied to clinical text for oncology AEs, focusing on three decision-linked tasks: (i) AE detection from clinical documentation, (ii) Common Terminology Criteria for Adverse Events (CTCAE) grade assignment, and (iii) grade-aligned actions. We also consider how these findings can inform pharmacist-facing recommendations for order-level safety. We conducted a narrative review of English-language studies indexed in PubMed, Ovid MEDLINE, and Embase. Eligible studies used LLMs on clinical narratives and/or authoritative guidance as model inputs or reference standards; non-text modalities and non-empirical articles were excluded. Nineteen studies met inclusion criteria. LLMs showed the potential to detect oncology AEs from routine notes and often outperformed diagnosis codes for surveillance and cohort construction. CTCAE grading was feasible but less stable than detection; performance improved when outputs were constrained to CTCAE terms/grades, temporally anchored, and aggregated at the patient level. Direct evaluation of grade-aligned actions was uncommon; most studies reported proxies (e.g., steroid initiation or drug discontinuation) rather than formal grade-to-action correctness. While prospective, real-world impact reporting remained sparse, several studies quantified scale advantages and time savings, supporting an initial role as high-recall triage with pharmacist adjudication. Overall, the evidence supports near-term, pharmacist-in-the-loop use of AI for AE surveillance and review, with CTCAE-structured, citation-backed outputs delivered into the pharmacist’s electronic health record order-verification workspace as reviewable artifacts. Future work must standardize reporting and CTCAE/version usage, and measure grade-to-action correctness prospectively, to advance toward order-level decision support. Full article
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9 pages, 240 KB  
Brief Report
Cost Analysis of Multidose Drug Dispensing (MDD) System Implementation in a Community Pharmacy in Portugal
by Ana Reis, Ângelo Jesus and Maria Luisa Martín
Pharmacy 2025, 13(6), 175; https://doi.org/10.3390/pharmacy13060175 - 1 Dec 2025
Viewed by 84
Abstract
Background: Community pharmacies are increasingly delivering structured services to support chronic disease management, such as Multidose Drug Dispensing (MDD). This strategy can improve adherence and safety, but evidence of its economic feasibility in Portuguese pharmacies remains limited. Objective: To estimate the cost of [...] Read more.
Background: Community pharmacies are increasingly delivering structured services to support chronic disease management, such as Multidose Drug Dispensing (MDD). This strategy can improve adherence and safety, but evidence of its economic feasibility in Portuguese pharmacies remains limited. Objective: To estimate the cost of implementing and operating an MDD system in a community pharmacy, informing reimbursement models and policy. Methods: A micro-costing approach assessed fixed and variable expenses for serving polymedicated elderly patients. Costs were calculated in euros (2024/2025) and expressed per working day based on 253 annual preparation days. Results: First-year costs totaled €70,985.68, including €8184.00 for setup, €21,579.00 for supplies, and €41,222.68 for staff salaries. The daily operating cost was €280.58, with labour representing the major expense. A break-even analysis indicated sustainability with around 700 users at €10/month. Conclusion: Although requiring significant initial investment, MDD can become financially viable through scaling, workflow efficiency, and supportive reimbursement strategies. Full article
14 pages, 223 KB  
Article
“But Will It Last?”: Examining How Pharmacy Staff Perceptions Influence Beliefs About the Sustainability of a Pharmacy-Based Intervention Targeting Older Adult Over-the-Counter (OTC) Medication Misuse
by Aaron M. Gilson, Katherine G. Moore, Stephanie M. Resendiz, Emily L. Hoffins, Shiying Mai, Jamie A. Stone and Michelle A. Chui
Pharmacy 2025, 13(6), 174; https://doi.org/10.3390/pharmacy13060174 - 1 Dec 2025
Viewed by 78
Abstract
Sustaining a well-designed healthcare intervention justifies the resources allocated during its conceptualization and implementation and maximizes its clinical benefits, but staff influences on sustainment have been studied insufficiently. This study evaluates the effects of pharmacy staff (i.e., pharmacists/technicians) perceptions about the sustainability of [...] Read more.
Sustaining a well-designed healthcare intervention justifies the resources allocated during its conceptualization and implementation and maximizes its clinical benefits, but staff influences on sustainment have been studied insufficiently. This study evaluates the effects of pharmacy staff (i.e., pharmacists/technicians) perceptions about the sustainability of Senior SafeTM, a U.S. pharmacy-based intervention to reduce older adult over-the-counter (OTC) medication misuse. Three months after introducing Senior Safe into 67 pharmacies in a large Midwestern health-system, all pharmacy staff (N = 279) received a survey invitation. Fifty-nine pharmacists and 94 technicians completed the survey. Using logistic regression modeling for the 14 belief-based survey items, and staff roles (pharmacist or technician), the final factors significantly predicting staff views that Senior Safe was sustainable were as follows: perceiving Senior Safe as well-integrated into leadership operations (OR = 5.606, p < 0.001) and believing the intervention reduced OTC misuse (OR = 8.217, p < 0.001). Also, technicians were more confident than pharmacists about Senior Safe’s sustainment and its OTC misuse reduction success. Overall, an intervention’s sustainability relies on those using it. Since the principal predictor of maintaining Senior Safe was its perceived effectiveness, increasing staff buy-in and awareness of an intervention’s benefits may be central to its long-term viability. With an aging U.S. population, sustainable solutions to older adult medication misuse remain critical. Full article
11 pages, 213 KB  
Article
Barriers and Opportunities in Cancer Pain Management: A Qualitative Study on Pharmacists’ Role
by Evangelos Aliferis, George Koulierakis, Christina Dalla and Tina Garani-Papadatos
Pharmacy 2025, 13(6), 173; https://doi.org/10.3390/pharmacy13060173 - 1 Dec 2025
Viewed by 69
Abstract
Introduction: Cancer pain remains a critical issue for patients’ quality of life, affecting their physiology, psychology, and social relationships. Despite the widely recognized role of pharmacists in pain management, their involvement in palliative care in Greece remains limited. This study focuses on exploring [...] Read more.
Introduction: Cancer pain remains a critical issue for patients’ quality of life, affecting their physiology, psychology, and social relationships. Despite the widely recognized role of pharmacists in pain management, their involvement in palliative care in Greece remains limited. This study focuses on exploring the perceptions and experiences of pharmacists regarding their role in cancer pain management, identifying barriers, required skills, and proposing strategies for their integration in the multidisciplinary team. Μaterials and Μethods: Qualitative research was conducted through semi-structured interviews with seven pharmacists in the Attica region. The interviews were recorded, transcribed, and thematically analyzed. Results: The analysis revealed four main themes: (1) limited access to medical records and challenges in pharmaceutical decision-making, (2) lack of institutional frameworks and a culture of collaboration, (3) need for specialized education and continuous training, and (4) understaffing and bureaucracy, faced by pharmacists. Discussion: This study highlights the underutilized role of pharmacists in cancer pain management in Greece. Barriers such as restricted access to patient records, weak interdisciplinary collaboration, insufficient training, and bureaucratic constraints limit their contribution. Structured frameworks and collaborative cultures can enhance pharmacists’ involvement, while education and continuous training are essential to strengthen their legitimacy within care teams. Digital tools can improve access to patient information and support evidence-based decisions. Conclusions: Pharmacists’ integration in the patient’s management team has significant benefits for the patient’s quality of life. Strengthening pharmacists’ involvement in cancer pain management requires the establishment of collaborations, continuous education, bureaucratic simplification, and the integration of digital tools. The development of practical resources, such as educational guides, can play a pivotal role in enhancing the quality of care provided. Full article
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13 pages, 1002 KB  
Article
Capturing Value: How Health-System Specialty Pharmacies Define and Document Pharmacist Interventions
by Autumn D. Zuckerman, Karen C. Thomas, Erica Diamantides, Shannan Takhar, Rushabh Shah, Kelsi Conant, Thom Platt and Christian Rhudy
Pharmacy 2025, 13(6), 172; https://doi.org/10.3390/pharmacy13060172 - 26 Nov 2025
Viewed by 235
Abstract
Standardized pharmacist intervention practices and documentation among health-system specialty pharmacies could improve understanding of the pharmacists’ role and value in this setting. This study describes current health-system specialty pharmacies’ intervention practices. A survey developed by a volunteer committee subgroup was distributed to two [...] Read more.
Standardized pharmacist intervention practices and documentation among health-system specialty pharmacies could improve understanding of the pharmacists’ role and value in this setting. This study describes current health-system specialty pharmacies’ intervention practices. A survey developed by a volunteer committee subgroup was distributed to two health-system specialty pharmacy group email distribution lists. The survey evaluated the types of tasks considered to be clinical or non-clinical interventions; who could perform interventions; where and how they were documented; data elements included in documentation; and how intervention data were classified, used, reviewed, and shared with internal or external stakeholders. Twenty-four institutions responded to the survey. Tasks within medication management, adverse drug events/monitoring, and education domains were more commonly considered clinical interventions; tasks in the health maintenance and coordination of care domains were more frequently considered non-clinical interventions or not considered to be interventions. Interventions were completed by pharmacists (at 100% of sites) and were mostly documented in the electronic health record (92%). Intervention data were primarily collected to meet accreditation purposes (96%) or for quality auditing and review (88%). No respondents shared intervention data with patients. Results demonstrate areas of alignment and variance in intervention definition and documentation among health-system specialty pharmacies. Full article
(This article belongs to the Section Pharmacy Practice and Practice-Based Research)
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13 pages, 243 KB  
Article
Job Satisfaction Among Pharmacists Graduating from a University in Northern Sweden: A Comparative Analysis
by Maria Gustafsson, Helena Norberg and Sofia Mattsson
Pharmacy 2025, 13(6), 171; https://doi.org/10.3390/pharmacy13060171 - 22 Nov 2025
Viewed by 377
Abstract
Job satisfaction plays a critical role in shaping professional outcomes, as it has been positively associated with enhanced performance and greater motivation. Conversely, insufficient job satisfaction may contribute to higher rates of staff turnover, professional burnout, and intentions to leave the profession. The [...] Read more.
Job satisfaction plays a critical role in shaping professional outcomes, as it has been positively associated with enhanced performance and greater motivation. Conversely, insufficient job satisfaction may contribute to higher rates of staff turnover, professional burnout, and intentions to leave the profession. The objective was to investigate job satisfaction among pharmacists educated at Umeå University in Sweden over time and to explore factors affecting job satisfaction. A survey was distributed to pharmacy graduates who had completed web-based pharmacy programs at Umeå University between 2019 and 2023. Questions regarding job satisfaction and factors related to it were included. The response rate was 38%. The results were compared with results from a previous investigation (graduation years 2015–2018) to enable comparisons over time. Compared to findings from the previous survey, job satisfaction was lower in the present study (76.4% vs. 91.4%, p = 0.004). Both greater opportunities for continuing professional development (CPD) and the perception that the knowledge and skills gained during education are beneficial in the current job were associated with high job satisfaction (OR: 5.360; 95% CI: 1.896–15.156 and OR: 3.983; 95% CI: 1.255–12.642, respectively). Understanding factors contributing to job satisfaction can help employers improve retention and work environment. Full article
32 pages, 950 KB  
Review
Medication Use by Older Adults with Frailty: A Scoping Review
by Rishabh Sharma, Tanaya Sharma, Brent McCready-Branch, Arshia Chauhan, Caitlin Carter, SooMin Park, Imra Hudani, Prapti Choudhuri and Tejal Patel
Pharmacy 2025, 13(6), 170; https://doi.org/10.3390/pharmacy13060170 - 21 Nov 2025
Viewed by 673
Abstract
Frailty among older adults heightens their risk of negative health outcomes, and medication use plays a major role in this increased vulnerability. Various aspects of medication use elevate the risk of poor outcomes in individuals with frailty. The current scoping review was designed [...] Read more.
Frailty among older adults heightens their risk of negative health outcomes, and medication use plays a major role in this increased vulnerability. Various aspects of medication use elevate the risk of poor outcomes in individuals with frailty. The current scoping review was designed to explore medication use in older adults with frailty in primary care, focusing on the prevalence of potentially inappropriate medications (PIMs), polypharmacy, medication adherence, and their role in contributing to adverse drug events. This scoping review was conducted using the Arksey and O’Malley, supplemented by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews (PRISMA-ScR) guidelines. A search of the literature was conducted from inception to November 2023 in Ovid EMBASE, PubMed (MEDLINE), Scopus, EBSCOhost CINAHL, and Ovid International Pharmaceutical Abstracts. Studies which met the eligibility criteria included older adults with frailty (≥65 years) living at home, defined frailty criteria, and assessment of medication use. Out of the 4726 studies screened, 223 were included, conducted across 39 countries. Frailty prevalence varied widely from 0.9% to 89.2%. Polypharmacy (5–9 medications) and hyper-polypharmacy (≥10 medications) were notably more common among individuals with frailty, with polypharmacy rates ranging from 1.3% to 96.4%. Twelve studies reported PIM prevalence among individuals with varying levels of frailty, ranging from 2.4% to 95.9%. This scoping review highlights the challenges and complexities involved in understanding the relationship between medication use and frailty in older adults. Full article
(This article belongs to the Section Pharmacy Practice and Practice-Based Research)
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36 pages, 4070 KB  
Review
Monoclonal Antibodies as a Breakthrough in Personalised Leukaemia Therapy: What Pharmacists and Doctors Should Know
by Anastasiia Ryzhuk, Sergiy M. Kovalenko, Marine Georgiyants, Kateryna Vysotska and Victoriya Georgiyants
Pharmacy 2025, 13(6), 169; https://doi.org/10.3390/pharmacy13060169 - 20 Nov 2025
Viewed by 509
Abstract
Monoclonal antibodies (mAbs) are an important medical innovation in modern medicine. They are an effective therapy for several subtypes of leukaemia but may have undesirable effects, which may be minimised through the provision of interdisciplinary care including a pharmacist. The goals of this [...] Read more.
Monoclonal antibodies (mAbs) are an important medical innovation in modern medicine. They are an effective therapy for several subtypes of leukaemia but may have undesirable effects, which may be minimised through the provision of interdisciplinary care including a pharmacist. The goals of this narrative review were twofold: first, to summarise the literature on the side effects of mAbs and the challenges of their preparation, and to provide recommendations for the safe preparation of mAb drug formulations for clinicians. Second, to suggest clinical roles for pharmacists to improve patient safety and clinical outcomes for leukaemia patients receiving mAb therapy. The review covers data from 178 scientific and official sources of information on the types of targeted immunobiological drugs for the treatment of various types of leukaemia. The results are a detailed description of the possible side effects from mAb therapy and a list of suggested actions that can be taken to prevent them. Pharmaceutical aspects of the use of mAbs, such as pharmacoeconomics, compounding and stability, are also discussed. The discussion is organised according to the current classification of leukaemia. The drugs considered include blinatumomab, inotuzumab ozogamicin, gemtuzumab ozogamicin, rituximab, ofatumumab, obinutuzumab, and alemtuzumab. The review offers a comprehensive resource to equip pharmacists and other clinicians to optimise mAb therapy and promote the safe use of these novel therapies. Full article
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12 pages, 831 KB  
Article
Effects of Modifying Supportive Care Medications in Combination Therapy with Pertuzumab, Trastuzumab, and Taxane Anticancer Drugs
by Mina Takagi, Shinichiro Maeda, Makiko Maeda, Yasushi Fujio and Sachiko Hirobe
Pharmacy 2025, 13(6), 168; https://doi.org/10.3390/pharmacy13060168 - 17 Nov 2025
Viewed by 340
Abstract
Chemotherapy for breast cancer includes pertuzumab and trastuzumab regimens with docetaxel (PHD) or paclitaxel (PHP). Current approaches for using supportive care drugs to manage the side effects of PHD and PHP are unclear. Here, we investigated the occurrence of side effects before and [...] Read more.
Chemotherapy for breast cancer includes pertuzumab and trastuzumab regimens with docetaxel (PHD) or paclitaxel (PHP). Current approaches for using supportive care drugs to manage the side effects of PHD and PHP are unclear. Here, we investigated the occurrence of side effects before and after supportive care medications were modified by discontinuing antipyretic analgesics. We retrospectively analyzed adverse events that occurred within 24 h of treating 76 patients with PHD or PHP. The frequencies of adverse effects in the groups before and after modification did not differ significantly (45.5% [15/33] and 44.2% [19/43], respectively). Severity also did not significantly differ between the groups. Therefore, discontinuing antipyretic analgesics as supportive care drugs had little effect on the frequency of side effects. Symptoms of feeling hot, pyrexic, and flushed were frequent, and their severity increased in the group after the support drugs were modified. Discontinuation of supportive care medications, including antipyretic analgesics, might affect the severity of certain symptoms and lead to the development of side effects that require medical intervention. Overall, our findings indicate the need to consider premedication with antipyretic analgesics, including further analysis of the risk factors that can predict symptoms. Full article
(This article belongs to the Section Pharmacy Practice and Practice-Based Research)
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14 pages, 536 KB  
Article
Pharmacist Intervention Models in Drug–Drug Interaction Management in Prescribed Pharmacotherapy
by Ivana Samardžić, Ivana Marinović, Iva Marović, Nikolina Kuča and Vesna Bačić Vrca
Pharmacy 2025, 13(6), 167; https://doi.org/10.3390/pharmacy13060167 - 17 Nov 2025
Viewed by 332
Abstract
Drug–drug interactions (DDIs) are one of the most common problems related to drug administration which represent a risk for patient safety. Considering their position in the healthcare system, pharmacists should be more proactively involved in DDI management. The paper shows representation of DDI [...] Read more.
Drug–drug interactions (DDIs) are one of the most common problems related to drug administration which represent a risk for patient safety. Considering their position in the healthcare system, pharmacists should be more proactively involved in DDI management. The paper shows representation of DDI intervention models in each DDI category. This research enrolled outpatients prescribed pharmacotherapies from 40 randomly selected community pharmacies. DDIs were analyzed using Lexicomp® Lexi-InteractTM Online (Lexi-Comp, Inc., Hudson, NY, USA) software. Clinical pharmacists’ panel, according to the necessary interventions, determined an independent model of pharmacist interventions (category 1) and models that require cooperation with physicians (category 2) for DDI management. In total, 4107 patients were enrolled in the study. Mean patient age was 67.5; they were mostly women (56.5%) and had on average of 3.4 diagnosis and 5.5 prescription drugs. Overall, 14,175 potential clinically significant DDIs were identified: 83.3% of C, 15.4% of D, and 1.3% of X category. At least one potential DDI was found in 78.6% of patients. Models of pharmacist DDI interventions in collaboration with a physician (category 2) were more prevalent than independent models (category 1): 57.5% vs. 42.5% in C category DDIs, 97.8% vs. 2.2% in D category, and 100% vs. 0% in category X DDIs. This research aimed to gain an insight into the distribution of interventions in DDI management models between physicians and pharmacists, which can contribute to more efficient pharmaceutical care and visibility. Full article
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15 pages, 386 KB  
Article
Experiences Reported by People with Epilepsy During Antiseizure Medication Shortages in the UK: A Cross-Sectional Survey
by Eric Amankona Abrefa Kyeremaa, Tom Shillito, Caroline Smith, Charlotte Lawthom, Sion Scott and David Wright
Pharmacy 2025, 13(6), 166; https://doi.org/10.3390/pharmacy13060166 - 10 Nov 2025
Viewed by 524
Abstract
(1) Background: Medication shortages have become increasingly common in the UK. However, there is limited evidence regarding the experiences of people with epilepsy and their caregivers during these shortages. The aim of this study is to explore the extent and impact of ASM [...] Read more.
(1) Background: Medication shortages have become increasingly common in the UK. However, there is limited evidence regarding the experiences of people with epilepsy and their caregivers during these shortages. The aim of this study is to explore the extent and impact of ASM shortages on people with epilepsy and their caregivers across the UK. (2) Methods: A cross-sectional online survey was distributed between January and April, 2024 by epilepsy charities. Participants included people with epilepsy and caregivers. The survey collected demographic information, types of ASM respondents were prescribed, experiences of shortages, and the impact of shortages. Data were analysed descriptively, and subgroup analyses were conducted by medication type. (3) Results: A total of 1549 responded, of whom 1312 were people with epilepsy and their carers who were included in the analysis with a mean age of 43 years. A total of 941 respondents (71.7%) reported difficulty obtaining their prescribed ASM in the past year. Shortages were most frequently reported for sodium valproate (60.8%), lamotrigine (65.2%), carbamazepine (92.6%), clobazam (82.6%), topiramate (81.5%), zonisamide (74.0%), levetiracetam (62.8%), lacosamide (71.0%), and brivaracetam (70.5%). A total of 529 (40.4%) of the participants reported that stress and/or anxiety caused by medication shortages was associated with recurrent seizures. We did not ask whether patients missed medications because of these difficulties. (4) Conclusions: ASM shortages are a widespread issue for people with epilepsy in the UK, leading to treatment disruptions and psychological distress. Addressing supply change limitations and identifying effective approaches to preventing the substitution of ASMs brands by clinicians may potentially reduce this problem. Full article
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14 pages, 225 KB  
Article
Bedside Medication Management: Pharmacy Technicians Managing Patient Medication Supply to Improve Nursing Productivity and Patient Safety
by Tom W. Simpson, Duncan S. Mckenzie, Rosina G. Guastella and Michael J. Ryan
Pharmacy 2025, 13(6), 165; https://doi.org/10.3390/pharmacy13060165 - 7 Nov 2025
Viewed by 358
Abstract
Audits of medication charts conducted by Royal Hobart Hospital Pharmacy revealed that dose omission was the most common medication error experienced by patients. Investigation of these errors also found that nurses spend significant time organising medication for inpatients. To address the issues contributing [...] Read more.
Audits of medication charts conducted by Royal Hobart Hospital Pharmacy revealed that dose omission was the most common medication error experienced by patients. Investigation of these errors also found that nurses spend significant time organising medication for inpatients. To address the issues contributing to these problems, an alternative model of medication management was implemented and tested. This model of bedside medication management involves medication supply managed by ward pharmacy technicians who review charts daily for changes to medicines and obtain the medicines needed for each patient. Outcomes on two intervention wards showed that the model, combined with technician involvement in controlled medicines stock management, resulted in 29.78 h of nursing time released to patient care per 20-bed ward per week, for an investment of 22.28 h of ward pharmacy technician time; a 75% reduction in delayed doses; a 44% reduction in missed doses; and an average decrease of two hours in the turnaround time for supply of inpatient medication. Introducing bedside medication management and controlled medicines stock management activities can release 1.34 h of nursing time to patient care for every hour of ward pharmacy technician time (at a lower hourly salary cost), decrease dose delays and omissions, and improve patient safety. Full article
13 pages, 502 KB  
Article
The Spectrum of Clinical Pharmacy Services in a Non-University Hospital—A Comprehensive Characterization Including a Risk Assessment for Drug-Related Problems and Adverse Drug Reactions
by Olaf Zube, Wiebke Schlüter, Johanna Dicken, Jan Hensen and Thilo Bertsche
Pharmacy 2025, 13(6), 164; https://doi.org/10.3390/pharmacy13060164 - 6 Nov 2025
Viewed by 402
Abstract
Background: Clinical pharmacy services (CPS) have been shown to confer significant advantages in patient care. It remains to be clarified how CPS resources are allocated across routine care settings. It remains to be clarified which recommendations are made to resolve the drug-related problems [...] Read more.
Background: Clinical pharmacy services (CPS) have been shown to confer significant advantages in patient care. It remains to be clarified how CPS resources are allocated across routine care settings. It remains to be clarified which recommendations are made to resolve the drug-related problems (DRP) identified by CPS and which adverse drug reactions (ADR) actually arise from the identified DRP. Methods: Following positive ethical approval, patient chart analyses, evaluation of pharmacy documentation on CPS and pharmacist interviews were performed to characterize CPS at all medical departments of the Bundeswehr Hospital Hamburg. We developed and pre-tested instruments for standardization: A Standard Operating Procedure (SOP) for the practical exercise and documentation of CPS by the pharmacists performing them, a standardized form (checklist) for retrospective data collection as part of this study, and a standardized questionnaire for conducting the pharmacist interviews including a risk assessment according to the NCC-MERP score. Results: In total, 1000 CPS were documented in 504 patients (mean age: 69.95 years; 229 female) on 16,705 treatment days. A total of 66.87% CPS was initiated when pharmacists participated in ward rounds. In all CPS, “Indications” was the topic addressed most frequently (37.70%). “Agents for obstructive respiratory diseases” was the most frequently involved drug class (11.32%). The most frequent processing time per CPS was 16–30 min (48.61%). The number of CPS ranged from 0.36/100 treatment days in dermatology to 12.47 in oncology. Severity of 358 DRP was classified “very severe” (5.03%), “severe” (42.74%), “moderate” (34.36%), “low” (15.08%), “very low” (1.40%), or “without impact” (1.40%). The probability of DRP occurrence was classified as “high” in 13.13% and “very high” in 3.35%. In 15.36% of the DRP, an ADR actually occurred. In 504 patients, 932 specific recommendations were forwarded to solve the DRP identified during CPS. Of those, 53.97% were implemented. Conclusions: In almost all CPS, a considerable number of DRP with serious clinical consequences were identified. Half of the forwarded recommendations were implemented. Full article
(This article belongs to the Section Pharmacy Practice and Practice-Based Research)
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21 pages, 712 KB  
Article
Assessment of Job Satisfaction and Intention to Quit Job Among Pharmacists in Saudi Arabia
by Ashwaq Alharthi, Maha Aleiban, Abdulrahman Alwhaibi, Moureq Alotaibi, Yousef Almutairi and Sultan Alghadeer
Pharmacy 2025, 13(6), 163; https://doi.org/10.3390/pharmacy13060163 - 5 Nov 2025
Viewed by 601
Abstract
Background/Objectives: Job satisfaction is an essential element for organizational functions. Working entities would not effectively operate without employee contentment. This study aimed to determine the level of job satisfaction among pharmacists and investigate its correlation with demographic variables and professional personal experience. Methods: [...] Read more.
Background/Objectives: Job satisfaction is an essential element for organizational functions. Working entities would not effectively operate without employee contentment. This study aimed to determine the level of job satisfaction among pharmacists and investigate its correlation with demographic variables and professional personal experience. Methods: A cross-sectional online survey targeting registered pharmacists in Saudi Arabia was conducted from September to November 2024 using an IRB-approved structured questionnaire adapted from validated instruments. Reliability and validity were confirmed (Cronbach’s α = 0.8), and a target sample of 380 was calculated to ensure representativeness. Data were analyzed using descriptive statistics, chi-squared tests, and univariate and multivariate logistic regression analyses utilizing SPSS v28, with significance set at p < 0.05. Results: A total of 330 pharmacists responded to the survey, representing 86.8% of the calculated sample size. Of those, 57% were male and 68.5% were staffing pharmacists. More than half of participants had professional experience of ≤5 years (57.3%), while 31.8% had 5 to 15 years of experience. Approximately 60% of participants worked in shift systems and reported dissatisfaction with their pay (70%) and lack of benefits (66.7%). Of all participants, only 26.4% confirmed satisfaction with their job and no intention to quit, while 23% clearly reported job dissatisfaction and an intention to quit; the rest of the participants were undecided (50.6%). Significant correlations were found between job satisfaction and variables such as education, current position, organization type, monthly income, and professional experience. Additionally, most of the items assessing professional personal experience such as working in a shift system, working as a team member, gaining financial benefits, and having accomplishments or growth opportunities at work were significantly correlated with job satisfaction. Opportunities for professional development, promotion, and a positive work environment were also frequently selected as factors contributing to job satisfaction (60.6%, 75.2% and 75.5%, respectively). Interestingly, motivation showed minimal impact on participants’ opinions regarding job satisfaction and decisions over whether to quit their jobs. Finally, occupation and age were found to significantly influence work environments, promotions, and opportunities, which consequently impact participants’ satisfaction towards their jobs. Conclusions: Our findings indicate that Saudi pharmacists experience low-to-moderate job dissatisfaction, with a significant percentage considering quitting form their jobs. Improving monetary rewards, recognition, and career advancement opportunities could improve job satisfaction and retention in this crucial workforce. Full article
(This article belongs to the Special Issue Pharmacy Workflow Optimization: Strategies for Enhancing Efficiency and Patient Satisfaction)
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12 pages, 228 KB  
Perspective
Healthcare Practice Post COVID-19 Impacts: Will 21st Century Pharmacists Become Global, Agile, Collaborative and Curated?
by Maree Donna Simpson, Jaimy Jose and Jennifer L. Cox
Pharmacy 2025, 13(6), 162; https://doi.org/10.3390/pharmacy13060162 - 3 Nov 2025
Viewed by 486
Abstract
“Those that fail to learn from history are doomed to repeat it.” Winston Churchill. In recent times, globally, approximately three pandemics and thousands of natural disasters and political upheavals have been recorded. In most cases, tens to hundreds of thousands of [...] Read more.
“Those that fail to learn from history are doomed to repeat it.” Winston Churchill. In recent times, globally, approximately three pandemics and thousands of natural disasters and political upheavals have been recorded. In most cases, tens to hundreds of thousands of people have died as a result, whether from droughts, famines, floods, earthquakes, tsunamis, wildfires, landslides, cyclones, typhoons, hurricanes, extreme heat, emerging or resurgent diseases or longer-term issues such as sustainability, climate change and/or global warming. Whilst many accommodations may have been made to cope with these, we propose that pharmacy education and professional practice benefit from learning from the past, from collaboration globally to manage the hectic and uncertain times that result from these disruptions and from curation and evaluation of these initiatives for ongoing and/or future use. Full article
(This article belongs to the Collection New Insights into Pharmacy Teaching and Learning during COVID-19)
12 pages, 234 KB  
Article
Socioeconomic Determinants of Career Intention in Pharmacy Students in Vietnam
by Quang Ngoc Phan, Oanh Thi Kim Nguyen, Hoa Thi Tran, Ngoc Bao Dang and Nam Hoang Tran
Pharmacy 2025, 13(6), 161; https://doi.org/10.3390/pharmacy13060161 - 2 Nov 2025
Viewed by 622
Abstract
Background: The pharmacy workforce in Vietnam is rapidly evolving, but little is known about how gender and socioeconomic factors shape career intentions and sector preferences of students. Understanding these determinants is essential for healthcare workforce planning. Objective: To investigate how gender and socioeconomic [...] Read more.
Background: The pharmacy workforce in Vietnam is rapidly evolving, but little is known about how gender and socioeconomic factors shape career intentions and sector preferences of students. Understanding these determinants is essential for healthcare workforce planning. Objective: To investigate how gender and socioeconomic determinants influence intention of pharmacy students to pursue a career and their preferred sector in Vietnam. Methods: A cross-sectional survey was conducted among 462 students from 2nd to 5th year at a Vietnamese university. Demographic data, socioeconomic background, and career intentions were analyzed using chi-squared tests, multinomial logistic regression, and binary logistic regression. Results: Of 462 respondents, 71.9% intended to pursue a pharmacy career, 2.6% reported no, while 25.5% were unsure. Gender differences were evident but did not reach statistical significance (p = 0.083). Female students were more likely to choose clinical, hospital pharmacy or regulation, whereas male students showed higher preference for community, industry and academia. Binary logistic regression revealed that urban origin (OR = 1.34, 95% CI = 1.01–1.78, p = 0.041) and family encouragement (OR = 2.53, 95% CI = 1.60–3.99, p < 0.001) significantly predicted career intention, while gender and income were non-significant. Conclusions: Family encouragement and urban upbringing influence pharmacy career pursuit, while gender may shape sectoral preferences. Policies should address gender equity and enhance support for students from rural or disadvantaged backgrounds. Full article
(This article belongs to the Special Issue Women's Special Issue Series: Pharmacy and Pharmacists)
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9 pages, 720 KB  
Case Report
Extemporaneous Preparation and Effectiveness of Low-Dose Naltrexone for the Treatment of Uremic Pruritus: A Literature Review and Case Report
by Dhakrit Rungkitwattanakul, Michelle Brooks, Simeon Adesina, Sanaa Belrhiti, Weerachai Chaijamorn, Taniya Charoensareerat, Uzoamaka Nwaogwugwu and Constance Mere
Pharmacy 2025, 13(6), 160; https://doi.org/10.3390/pharmacy13060160 - 1 Nov 2025
Viewed by 648
Abstract
Background: Uremic pruritus is one of the most debilitating complications among patients with end-stage kidney disease (ESKD) receiving hemodialysis. For patients who are refractory to traditional therapies (topical analgesics, antihistamines, or gabapentinoids), the use of low-dose naltrexone can be an option where difelikefalin [...] Read more.
Background: Uremic pruritus is one of the most debilitating complications among patients with end-stage kidney disease (ESKD) receiving hemodialysis. For patients who are refractory to traditional therapies (topical analgesics, antihistamines, or gabapentinoids), the use of low-dose naltrexone can be an option where difelikefalin is not available. Case report: In our case report, we present a case of a female patient who developed intractable uremic pruritus despite the adequate trials of traditional therapies. The patient was initiated with low-dose naltrexone of 5 mg daily. Uremic symptoms improved within 3 days of naltrexone initiation. The side effects were tolerated. Conclusion: Low-dose naltrexone provided symptomatic improvement in individuals with severe uremic pruritus when difelikefalin was inaccessible. While limited to a single case, this report highlights the potential role of naltrexone and underscores the need for further research to establish its safety and efficacy. Full article
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14 pages, 776 KB  
Article
Hospital Pharmacists’ Perspectives on Documenting and Classifying Pharmaceutical Interventions: A Nationwide Validation Study in Portugal
by Sara Machado, Fátima Falcão and Afonso Miguel Cavaco
Pharmacy 2025, 13(6), 159; https://doi.org/10.3390/pharmacy13060159 - 1 Nov 2025
Viewed by 684
Abstract
Pharmacist interventions (PIs) are central to optimising pharmacotherapy, preventing drug-related problems, and improving patient outcomes. In Portugal, the absence of a validated tool to consistently document and classify PIs limits data comparability and service development. Given these gaps, this study aimed to describe [...] Read more.
Pharmacist interventions (PIs) are central to optimising pharmacotherapy, preventing drug-related problems, and improving patient outcomes. In Portugal, the absence of a validated tool to consistently document and classify PIs limits data comparability and service development. Given these gaps, this study aimed to describe hospital pharmacists’ attitudes towards PI documentation and classification, following confirmatory factor analysis (CFA) of a survey instrument, and to provide a comprehensive overview of current practices and behaviours in hospital settings across Portugal. An online questionnaire, previously validated, was distributed online to all hospital pharmacists registered with the Portuguese Pharmaceutical Society (October–December 2024). Sociodemographic data and the cognitive and behavioural domains of pharmacists’ attitudinal model were analysed descriptively, and CFA tested the three-factor structure (Process, Outcome, Satisfaction) of the attitudinal affective domain. Of 1848 pharmacists, 260 responded (14%). Respondents reported performing a mean of 49 PIs/month (SD = 196), although many never recorded (28.8%), classified (56.2%), or analysed (52.3%) interventions. Only 2.7% declared to use a validated classification framework. The CFA supported the structural coherence of the Process factor but revealed some overlapping between Process and Outcome and instability in the Satisfaction factor. The nationwide scope and application of CFA provided partial support for the hypothesised model and highlighted areas for refinement, including revision of Satisfaction items and reconsideration of Process and Outcome as overlapping constructs. Findings highlight strong professional commitment to PIs but persistent barriers, including less clear procedures and satisfaction, underscoring the need for a unified, standardised national system to support consistent recording, classification, and evaluation. Full article
(This article belongs to the Section Pharmacy Practice and Practice-Based Research)
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24 pages, 1933 KB  
Review
Barriers and Facilitators of Using MyDispense from the Student Perspective: A Systematic Review
by Owen Collins, Ruth McCarthy and Laura J. Sahm
Pharmacy 2025, 13(6), 158; https://doi.org/10.3390/pharmacy13060158 - 1 Nov 2025
Viewed by 536
Abstract
MyDispense is a high-fidelity, low-stakes community pharmacy simulation, allowing students to practice dispensing skills. A systematic review was conducted to identify students’ perceptions regarding barriers and facilitators of MyDispense in pharmacy education. PubMed, CINAHL, and EMBASE databases were searched from 2015 to 2025 [...] Read more.
MyDispense is a high-fidelity, low-stakes community pharmacy simulation, allowing students to practice dispensing skills. A systematic review was conducted to identify students’ perceptions regarding barriers and facilitators of MyDispense in pharmacy education. PubMed, CINAHL, and EMBASE databases were searched from 2015 to 2025 in January 2025 using combined keywords, proximity searching and Boolean operators. Studies investigating MyDispense and gathering students’ perceptions were included. Record screening was conducted by two independent reviewers (OC and LS). Any identified records from database searching and hand searching of included study reference lists were imported to Rayyan and subjected to independent review. Conflicts were resolved through a third party (RMcC), and discussions were held until consensus was reached. Fifteen studies were included in this review. Seven studies were conducted in USA, six in Asia, one in UK, and one in Australia. All studies utilised purposive sampling. Sample sizes ranged from 33 to 322 students. All studies included surveys to gather student perceptions. Other data collection methods included semi-structured interviews and focus group discussions for students to further elaborate on survey responses. Identified facilitators were mapped to four overarching themes; “Develops competency”, “User-Friendliness”, “Engaging Learning Experience” and “Safe Learning Environment.” Key barriers were encompassed to three themes: “Learning Curve”, “IT issues” and “Limited Realism and Applications”. Barriers included (i) the learning curve of the platform, (ii) technical issues, and (iii) limited realism. Facilitators included perceptions of (i) improved dispensing and counselling skills and a deeper understanding of pharmacy legislation, (ii) accessibility, interactivity of the learning environment and (iii) immediate feedback. Synthesis of the evidence in this review identified students’ perceptions of barriers and facilitators of MyDispense in pharmacy education. This may serve as a guide to educators considering the adoption of MyDispense into their curricula. Full article
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25 pages, 1028 KB  
Review
Community Pharmacist Prescribing: Roles and Competencies—A Systematic Review and Implications
by Stephanie Clemens, Lea Eisl-Raudaschl, Johanna Pachmayr and Olaf Rose
Pharmacy 2025, 13(6), 157; https://doi.org/10.3390/pharmacy13060157 - 1 Nov 2025
Viewed by 929
Abstract
Increasing healthcare demands and physician shortages have prompted many countries to expand clinical responsibilities of pharmacists. Although Canada, the UK, and the US have implemented pharmacist prescribing, other nations lag behind. This review compares international roles, identifies inferred competencies, and explores implications for [...] Read more.
Increasing healthcare demands and physician shortages have prompted many countries to expand clinical responsibilities of pharmacists. Although Canada, the UK, and the US have implemented pharmacist prescribing, other nations lag behind. This review compares international roles, identifies inferred competencies, and explores implications for role expansion. A systematic search of MEDLINE, CINAHL, and the Cochrane Library was conducted using the PICO framework; studies were appraised with Critical Appraisal Skills Programme (CASP) checklists, and interrater reliability assessed via Cohen’s Kappa. Data from 23 studies were thematically synthesized following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Four themes emerged: (1) expanding clinical and public health roles and pharmacists’ self-perceived readiness; (2) regulatory frameworks defining legal authority, qualifications, and temporary pandemic exemptions; (3) inferred competencies, including micro-skills (patient assessment, guideline application) and macro-capabilities (clinical judgment, accountability, reflective practice); and (4) contextual barriers such as training gaps, limited funding, unclear legal provisions, and workflow challenges. Implementation implications were synthesized and included training, funding, acceptance, and integration. Evidence indicates pharmacist prescribing is safe and patient-centered when supported by regulation, structured training, and systemic integration. Insights from established models can guide incremental implementation, optimizing medication management, enhancing healthcare access, and promoting equitable care. Full article
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13 pages, 553 KB  
Review
How Have Entrustable Professional Activities (EPAs) Been Implemented in Pharmacy Education? A Scoping Review
by Luiz Claudio Oliveira Alves de Souza, Luciana Flavia de Almeida Romani and Marina Guimaraes Lima
Pharmacy 2025, 13(6), 156; https://doi.org/10.3390/pharmacy13060156 - 1 Nov 2025
Viewed by 529
Abstract
Entrustable Professional Activities (EPAs) are units of professional practice entrusted to learners once they have attained the required competencies to perform them. This scoping review described how Entrustable Professional Activities (EPAs) have been implemented in pharmacy education. MEDLINE (PubMed), Scopus, and Google Scholar [...] Read more.
Entrustable Professional Activities (EPAs) are units of professional practice entrusted to learners once they have attained the required competencies to perform them. This scoping review described how Entrustable Professional Activities (EPAs) have been implemented in pharmacy education. MEDLINE (PubMed), Scopus, and Google Scholar were searched (on 8 July 2025) to identify relevant literature from 2016 to 2025. Studies that describe EPAs implemented in pharmacy programs, assess the perspectives on EPAs implemented, or evaluate student performance on EPAs were included. Studies that did not assess actual experience of EPAs’ implementation were excluded. The data were described narratively and through frequencies and tables. Twenty-four studies were included in the review. Most studies pointed out that the EPAs’ framework has been adopted mostly in practice experiences, but with a few experiences in course activities. The most frequent approach to assess student performance on EPAs was direct practice observation. Student performance on EPAs improved after participating in educational activities. From the perspectives of students, preceptors, and faculty members, EPAs facilitated student assessment of competencies; however, there are challenges in their implementation, such as heavy workload. The findings of this review can inform faculty members and health professionals who intend to implement EPAs’ framework. Full article
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12 pages, 758 KB  
Article
Design and Implementation of a Competency-Based Training Program for Specialty Pharmacists in China
by Hamza El Alami, Ruoxin Huang, Nan Wu, Yufen Zheng and Pengyuan Wang
Pharmacy 2025, 13(6), 155; https://doi.org/10.3390/pharmacy13060155 - 1 Nov 2025
Viewed by 531
Abstract
This study describes the design, implementation, and evaluation of a Competency-Based Pharmacy Education (CBPE) program for 120 direct-to-patient (DTP) pharmacists in China, aimed at improving pharmaceutical care and pharmacotherapy skills. The program, which integrated Case-Based Learning (CBL) and Objective Structured Clinical Examination (OSCE), [...] Read more.
This study describes the design, implementation, and evaluation of a Competency-Based Pharmacy Education (CBPE) program for 120 direct-to-patient (DTP) pharmacists in China, aimed at improving pharmaceutical care and pharmacotherapy skills. The program, which integrated Case-Based Learning (CBL) and Objective Structured Clinical Examination (OSCE), included both online and in-person sessions. A cross-sectional analysis of participant performance and satisfaction showed a mean total OSCE score of 68.31. Participants demonstrated strengths in communication and documentation, with one-third of participants achieving high scores, while weaknesses were noted in patient education and care planning. Participant surveys revealed significant perceived improvements in communication and patient education skills among 62.5% of the participants. These findings suggest that CBPE is a promising approach for pharmacist training, advocating for its broader adoption to meet the evolving demands of healthcare and improve patient outcomes. Full article
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12 pages, 294 KB  
Article
Peer-Delivered Hepatitis C Testing and Health Screening Provided in a Community Pharmacy Setting: Proof of Concept
by Neha Sankla, Ray Cottington, Chris Cowie, Paul Huggett, Leila Reid, Stuart Smith, Sorcha Daly, Danny Morris, James Spear, Amanda Marsden, David Richards, Rachel Halford, Scott Walter and Jenny Scott
Pharmacy 2025, 13(6), 154; https://doi.org/10.3390/pharmacy13060154 - 27 Oct 2025
Viewed by 573
Abstract
In order to reach and maintain hepatitis C virus (HCV) elimination goals, it is imperative to reach marginalized people who do not engage with traditional testing and treatment. Peer-led interventions are effective in engaging such individuals. Studies have demonstrated community pharmacy as a [...] Read more.
In order to reach and maintain hepatitis C virus (HCV) elimination goals, it is imperative to reach marginalized people who do not engage with traditional testing and treatment. Peer-led interventions are effective in engaging such individuals. Studies have demonstrated community pharmacy as a low-threshold setting for HCV testing, but pharmacy teams’ competing demands are a barrier to maximizing potential. This pilot project aimed to assess whether a pharmacy-based peer-led model of HCV testing was implementable, deliverable, able to engage marginalized people, and overcome pharmacy staff constraints. We implemented a peer-led HCV testing service in one community pharmacy in the Midlands, England, providing four focused phases of testing, totalling 198 h, over two years. In total, 591 tests for antibodies or RNA were undertaken, identifying 24 active infections. Subsequent phases retested 20%, 16%, and 11% of those tested in combined preceding phases. In response to feedback, phases 3 and 4 included health screening (blood pressure, cholesterol, diabetes, and nurse-performed Fibroscans®). We demonstrate engagement and the ability to identify and refer those with abnormal results to appropriate healthcare. This pilot shows that peer-led testing in the pharmacy setting can be implemented and warrants further scale up and evaluation. Full article
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14 pages, 240 KB  
Article
Evaluation of Pharmacy Resident Burnout Based on Weekend Residency Staffing Requirements: A Pilot Study
by Andrew C. Hean, Jamie Kneebusch, Casey Tiefenthaler and Kelly C. Lee
Pharmacy 2025, 13(6), 153; https://doi.org/10.3390/pharmacy13060153 - 27 Oct 2025
Viewed by 1254
Abstract
Research surrounding impacts of staffing on pharmacy residents is limited. This prospective survey study aims to elucidate relationships between burnout and weekends staffed among California pharmacy residents. Postgraduate year 1 and 2 (PGY1 and PGY2) pharmacy residents completed electronic surveys in August 2023 [...] Read more.
Research surrounding impacts of staffing on pharmacy residents is limited. This prospective survey study aims to elucidate relationships between burnout and weekends staffed among California pharmacy residents. Postgraduate year 1 and 2 (PGY1 and PGY2) pharmacy residents completed electronic surveys in August 2023 and February 2024. The primary outcome was the difference in burnout score changes based on weekends required to staff (measured using the Maslach Burnout Inventory-Human Services Survey for Medical Personnel). Secondary subgroup analyses measured differences in burnout scores by the overall cohort, no weekend staffing vs. weekend staffing required, PGY1 vs. PGY2, and by changes in planned professional pursuits. Of 66 respondents, no significant differences in burnout scores were observed based on the number of weekends required to staff. Final mean emotional exhaustion (EE), but not depersonalization (DP) or personal accomplishment (PA), scores were significantly higher for all residents combined, increasing from 24.8 (SD 10.2) to 28.4 (SD 11.5). Final mean EE scores were also significantly higher among PGY2s compared to PGY1s, at 35.1 (SD 0.70) vs. 25.8 (SD 12.0), respectively. Final mean burnout scores were significantly worse in those becoming less likely to pursue board specialty certification across all domains, with EE = 32.6 (SD 6.50), DP = 4.29 (4.79), and PA = 36.3 (SD 3.21). Based on these results, staffing intensity alone may not be associated with burnout among California pharmacy residents, but PGY2 pharmacy residents may be at higher risk of burnout. Higher burnout scores may predict the likelihood of pursuing board specialty certification. Future studies assessing additional confounding factors with a broader scope are needed to fully define risk factors for burnout in pharmacy residents. Full article
(This article belongs to the Section Pharmacy Education and Student/Practitioner Training)
16 pages, 213 KB  
Article
Responsible Adoption of Artificial Intelligence (AI) in Pharmacy Practice: Perspectives of Regulators in Canada and the United States
by Paul A. M. Gregory and Zubin Austin
Pharmacy 2025, 13(6), 152; https://doi.org/10.3390/pharmacy13060152 - 27 Oct 2025
Viewed by 1270
Abstract
Background: Use of Artificial Intelligence (AI) is proliferating in society and in pharmacy practice. For some, this represents a great advancement that will enhance effectiveness and efficiency of health care. For others, it is an existential risk that will worsen inequalities, lead to [...] Read more.
Background: Use of Artificial Intelligence (AI) is proliferating in society and in pharmacy practice. For some, this represents a great advancement that will enhance effectiveness and efficiency of health care. For others, it is an existential risk that will worsen inequalities, lead to deskilling of the workforce, and spiral beyond the comprehension or control of humans. Human-in-the-loop (HiL) vs. human-out-of-the loop (HoL) AI have different potential risks and challenges that raise questions regarding patient safety. Defining principles for responsible adoption of AI in pharmacy practice will be an important safeguard for both patients and the profession. Methods: Semi-structured interviews with 12 pharmacy regulators from across Canada and the United States were undertaken, with informed consent. Constant comparative data analysis using nVivo v15 was used to identify common themes. The COREQ framework was applied to assure quality of research processes used. Results: Pharmacy regulators highlighted the value of a principles-based, rather than rules-based, approach to AI. Core principles related to transparency, redundancy, audit and feedback, quality assurance, privacy/data security, alignment with codes of ethics, and interoperability were identified. There was limited consensus on the role of consent and choice as principles to be considered. Conclusions: The role of regulation in shaping responsible adoption of AI in pharmacy will be significant. This study highlighted a series of agreed-upon principles but also identified lack of consensus with respect to how consent and choice could be operationalized in pharmacy practice. Full article
(This article belongs to the Special Issue AI Use in Pharmacy and Pharmacy Education)
36 pages, 2417 KB  
Review
Optimizing Drug Therapy in ECMO-Supported Critically Ill Adults: A Narrative Review and Clinical Guide
by Abraham Rocha-Romero, Jose Miguel Chaverri-Fernandez, Fianesy Chaves-Fernández and Esteban Zavaleta-Monestel
Pharmacy 2025, 13(6), 151; https://doi.org/10.3390/pharmacy13060151 - 23 Oct 2025
Viewed by 1001
Abstract
Extracorporeal membrane oxygenation (ECMO) is increasingly used to support critically ill adults with severe cardiac or respiratory failure, but ECMO circuits and the physiological disturbances of critical illness significantly alter drug pharmacokinetics (PK) and pharmacodynamics (PD), complicating dosing and monitoring. This narrative review [...] Read more.
Extracorporeal membrane oxygenation (ECMO) is increasingly used to support critically ill adults with severe cardiac or respiratory failure, but ECMO circuits and the physiological disturbances of critical illness significantly alter drug pharmacokinetics (PK) and pharmacodynamics (PD), complicating dosing and monitoring. This narrative review synthesizes current clinical evidence on ECMO-related PK/PD alterations and provides practical guidance for optimizing pharmacotherapy in adult intensive care. A structured literature search (January–May 2025) was conducted across PubMed/MEDLINE, EMBASE, Scopus, Cochrane Library, Sage Journals, ScienceDirect, Taylor & Francis Online, SpringerLink, and specialized databases, focusing on seven therapeutic classes commonly used in ECMO patients. Eligible studies included clinical trials, observational studies, systematic reviews, and practice guidelines in adults, while pediatric and preclinical data were excluded. Evidence quality varied substantially across drug classes. Hydrophilic, low-protein-bound agents such as β-lactams, aminoglycosides, fluconazole, and caspofungin generally showed minimal ECMO-specific PK alterations, with dose adjustment mainly driven by renal function. Conversely, lipophilic and highly protein-bound drugs including fentanyl, midazolam, propofol, voriconazole, and liposomal amphotericin B exhibited substantial circuit adsorption and variability, often requiring higher loading doses, prolonged infusions, and rigorous therapeutic drug monitoring. No ECMO-specific data were identified for certain neuromuscular blockers, antivirals, and electrolytes. Overall, individualized dosing guided by therapeutic drug monitoring (TDM), organ function, and validated PK principles remains essential to optimize therapy in this complex population. Full article
(This article belongs to the Section Pharmacy Practice and Practice-Based Research)
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