Search Results (182)

Background/Objectives: Hypertension (HTN) continues to be a leading cause of death and disability in older adults, especially in the southeastern United States. A cross-sectional study was conducted to evaluate the relationships among measured, diagnosed, and treated (HTN) in community-dwelling adults participating in student-led health screenings in eastern Alabama. Methods: Between 2017 and 2019, students from health-related disciplines facilitated screenings at 23 community and independent living sites to conduct health assessments, including measuring blood pressure (BP), obtaining medical history, and evaluating current prescriptions. Statistical analyses including chi-square tests, t-tests, and backward stepwise linear regression were performed. Results: The current sample includes data from 357 adults aged 60 to 99 years (mean age 74.6 ± 8.7), who were 70.9% females, 60.8% identifying as Black/African American (BA), and 36.8% residing in rural areas. The majority of clients had a prior HTN diagnosis (71.1%) and/or currently measured HTN (78.7%). Forty-three percent of adults screened had measured, diagnosed, and pharmaceutically treated HTN, while 31% had measured but untreated HTN. Black clients had higher measured systolic and diastolic BP and were more likely to also have been diagnosed with HTN (p < 0.05 for all). Linear regression indicated that lower systolic BP was predicted by not living alone (p = 0.003), White race (p = 0.004), and previous HTN diagnosis (p = 0.012), while female gender (p = 0.079) and decreasing body mass index (p = 0.053) had marginal predictive value. Conclusions: These results indicate that awareness and screening of HTN in this population are noteworthy, though management of the disease through ongoing screening and referrals is essential to reduce disparities. Full article

Traditional Chinese medicine (TCM), a holistic medical system rooted in dialectical theories and natural product-based therapies, has served as a cornerstone of healthcare systems for millennia. While its empirical efficacy is widely recognized, the polypharmacological mechanisms stemming from its multi-component nature remain poorly characterized. The conventional trial-and-error approaches for bioactive compound screening from herbs raise sustainability concerns, including excessive resource consumption and suboptimal temporal efficiency. The integration of artificial intelligence (AI) and multi-omics technologies with network pharmacology (NP) has emerged as a transformative methodology aligned with TCM’s inherent “multi-component, multi-target, multi-pathway” therapeutic characteristics. This convergent review provides a computational framework to decode complex bioactive compound–target–pathway networks through two synergistic strategies, (i) NP-driven dynamics interaction network modeling and (ii) AI-enhanced multi-omics data mining, thereby accelerating drug discovery and reducing experimental costs. Our analysis of 7288 publications systematically maps NP-AI–omics integration workflows for natural product screening. The proposed framework enables sustainable drug discovery through data-driven compound prioritization, systematic repurposing of herbal formulations via mechanism-based validation, and the development of evidence-based novel TCM prescriptions. This paradigm bridges empirical TCM knowledge with mechanism-driven precision medicine, offering a theoretical basis for reconciling traditional medicine with modern pharmaceutical innovation. Full article

Quinolones and fluoroquinolones are heterocyclic compounds with important antibacterial properties, and they have been extensively used in medicinal chemistry to treat diverse bacterial infections. However, their clinical applications have been limited by several factors. On one side, there is an increasing number of resistant bacterial strains. On the other side, some of these heterocyclic compounds have shown several adverse effects such as photocarcinogenic cutaneous reactions, with the development of skin tumors. These adverse properties have motivated a large number of studies on the photophysical, photochemical and phototoxic properties of these compounds. In this review, several important chemical aspects about quinolones and fluoroquinolones are discussed. In the first sections, their basic structure is presented, along with some important physicochemical properties. In the next sections, their photochemical and photophysical processes are discussed. Upon photolysis in aqueous neutral conditions, these heterocyclic compounds generate several highly reactive intermediates that could initiate diverse reactions with molecules. In a biological environment, quinolones and fluoroquinolones are known to associate with biomolecules and generate complexes. Within these complexes, photophysical and photochemical processes generate intermediates, accelerating diverse reactions between biomolecules and these heterocyclic compounds. For several decades, diverse fluoroquinolones have been prepared for the treatment of a variety of bacterial infections. However, their prescription has been restricted due to the associated severe side effects. In the last decade, new derivatives have been developed and are already in use. Their introduction into actual practice extends the number of antibiotics and provides new options for difficult-to-treat infections. Thus, for new pharmaceutical compounds to be used in medicinal practice, it is important to investigate their biological activity, as well as other biological properties and adverse effects, such as phototoxicity. Full article

Antimicrobial resistance (AMR) is considered a global healthcare emergency in the 21st century. Although the evolution of microorganisms through Darwinian mechanisms and antibiotic misuse are established drivers, the structural socioeconomic factors of AMR remain insufficiently explored. This review takes on an analytical perspective, drawing upon a wide spectrum of evidence to examine the extent to which socioeconomic factors contribute to the global proliferation of AMR, with an emphasis on low- and middle-income countries (LMICs). The analytical review at hand was carried out through a search for relevant articles and reviews on PubMed, Google Scholar, the Centers for Disease Control and Prevention, and the World Health Organization database using combinations of the keywords “antimicrobial resistance,” “socioeconomic factors,” “low- and middle-income countries,” “surveillance,” “healthcare access,” and “agriculture.” Preference was given to systematic reviews, high-impact primary studies, and policy documents published in peer-reviewed journals or by reputable global health organizations. Our analysis identifies a complex interplay of systemic vulnerabilities that accelerate AMR in resource-limited settings. A lack of regulatory frameworks regarding non-prescription antibiotic use enables the proliferation of multi-drug-resistant microorganisms. Low sewer connectivity facilitates the environmental dissemination of resistance genes. Proper antibiotic selection is hindered by subpar healthcare systems and limited diagnostic capabilities to deliver appropriate treatment. Additionally, gender disparities, forced migration, and climate-driven zoonotic transmission compound the burden. During the COVID-19 pandemic, antimicrobial misuse surged, further amplifying resistance trends. AMR is not solely a biological phenomenon, but a manifestation of global inequity. Mitigation requires a transformation of policy directed toward a “One Health” strategy that incorporates socioeconomic, environmental, and health system reforms. Strengthening surveillance, investing in infrastructure, regulating pharmaceutical practices, and promoting health equity are essential to curb the rising tide of resistance. Full article

Objectives: We investigate the long-run impact of changes in prescription drug sales on mortality and hospital utilization in Belgium during the first two decades of the 21st century. Methods: We analyze the correlation across diseases between changes in the drugs used to treat the disease and changes in mortality or hospital utilization from that disease. The measure of the change in prescription drug sales we use is the long-run (1998–2018 or 2000–2019) change in the fraction of post-1999 drugs sold. A post-1999 drug is a drug that was not sold during 1989–1999. Results: The 1998–2018 increase in the fraction of post-1999 drugs sold is estimated to have reduced the number of years of life lost before ages 85, 75, and 65 in 2018 by about 438 thousand (31%), 225 thousand (31%), and 114 thousand (32%), respectively. The 1995–2014 increase in in the fraction of post-1999 drugs sold is estimated to have reduced the number of hospital days in 2019 by 2.66 million (20%). Conclusions: Even if we ignore the reduction in hospital utilization attributable to changes in pharmaceutical consumption, a conservative estimate of the 2018 cost per life-year before age 85 gained is EUR 6824. We estimate that previous changes in pharmaceutical consumption reduced 2019 expenditure on inpatient curative and rehabilitative care by EUR 3.55 billion, which is higher than the 2018 expenditure on drugs that were authorized during the period 1998–2018: EUR 2.99 billion. Full article

Background: The effective management of psychotic and bipolar disorders in tertiary care can improve patient outcomes, yet the role of clinical pharmacists in optimising psychotropic medication use remains underexplored in South Africa. This study aims to investigate the role and interventions of clinical pharmacists in managing psychotic and bipolar disorders within a tertiary hospital in South Africa. Methods: A quantitative, descriptive study was conducted among 60 adult patients admitted to the psychiatric and internal medicine wards diagnosed with psychotic and/or bipolar disorder. A previously validated, standardised pharmaceutical care form was utilised for a purposive sample of inpatient files. Medication-related problems were identified, and appropriate interventions were suggested. Prescriptions were also assessed for adherence to treatment guidelines, including the South African Standard Treatment Guidelines, the American Psychiatric Association guidelines, and the National Institute for Health and Care Excellence guidelines. Results: The study included 60 patients (37 females) with a mean age of 37 years. Diagnoses included schizophrenia (28.8%), bipolar disorder (27.5%), and stimulant-induced psychosis (19.3%). Sixty-two medication-related problems were identified, leading to 77 proposed interventions, of which 65 were implemented. Among the prescriptions, 75% (n = 45) adhered to the South African Standard Treatment guidelines, 76% (n = 46) adhered to the NICE guidelines, and 71% (n = 43) adhered to the APA guidelines. Conclusions: Clinical pharmacists identified a number of medication-related problems in patients with psychotic and bipolar disorders, and their proposed interventions were largely accepted. The findings highlight the pharmacist’s role in optimising medication therapy and adherence to guidelines, suggesting that improved treatment monitoring is necessary in this setting. Full article

Medication misidentification poses a significant risk to patient safety, particularly for elderly individuals managing complex prescriptions. To address this, we developed a deep learning-based system for real-time medication recognition on mobile devices. Through a comparative analysis of convolutional neural networks, ResNet101 was selected for its superior performance, achieving 98.51% accuracy on a dataset from the Korea Pharmaceutical Information Center. The system employs advanced preprocessing techniques, including image augmentation and normalization, to ensure robustness across diverse conditions. Heatmap-based visualizations enhance model interpretability, fostering trust in their decisions. Deployed as a user-friendly mobile application, the system prioritizes accessibility for elderly users, offering a practical solution to reduce medication errors. This research demonstrates the potential of AI-driven mobile health applications to improve pharmaceutical safety and patient outcomes. Full article

Background/Objectives: Oral anticoagulant (OA) therapy (OAT) may be prescribed to patients for a variety of reasons, with several agent classes currently available as well as emerging. The classical oral anticoagulants are represented by vitamin K antagonists (VKAs), including warfarin, and the more modern alternatives comprise the direct oral anticoagulants (DOACs). We aimed to assess usage of OAs over time in Australia, especially focusing on the period of the coronavirus disease 2019 (COVID-19) pandemic and its transition to an endemic phase, to assess for any trends. Methods: Using data from the pharmaceutical benefits scheme (PBS), Medicare and other online sites, we specifically assessed for changes in OA prescription and cost patterns over the period 1992–2024, but focusing especially on the period 2020–2024 inclusive. Results: Apixaban is now the most prescribed OA in Australia. Costs of OAT prescriptions have steadily increased over the data capture period, reaching half a billion dollars in 2023. Interestingly, costs have started to fall, seemingly driven by the release of DOAC generics and PBS pricing adjustments. We could identify no clear signals related to COVID-19-related changes in prescription trends, contrary to previous reports in other locations. Conclusions: We provide Australian data on both OA usage as well as costs. Despite an ongoing trend to increasing use of DOACs over VKAs, we could not identify any specific COVID-19-related changes. Full article

Drug safety is crucial in healthcare, ensuring the secure and effective administration of medications to protect patient welfare. Drug and medication safety is a major concern among Saudi healthcare providers, with numerous studies outlining the incidence of medication errors and the need for enhanced safety standards. This review will examine the existing level of drug-related safety in Saudi Arabia, categorizing the areas for improvement and highlighting concepts to improve safety practices. The overview discusses the history and evolution of pharmaceutical safety procedures, the present regulatory framework, major stakeholders, and the types and origins of prescription errors. It also examines the role of healthcare personnel and the use of technology and patient education in promoting pharmaceutical safety. The data reveal that the rate of pharmaceutical errors in Saudi hospitals is shockingly high, ranging from 13 to 56 per 100 medication orders, highlighting the urgent need for effective medication safety standards. Despite the formation of the Saudi Food and Drug Authority (SFDA) and the National Pharmacovigilance and Drug Safety Centre, issues such as poor understanding among healthcare providers and the need for more effective reporting methods remain a challenge. The evaluation highlights the deficiencies in ongoing education, such as real-world case scenarios and related trainings, inadequate incorporation of skills in assessment methods, and deficiency in standardized protocols for error reporting. To address these gaps, it is proposed to implement structured competency-based training, simulation exercises must be preferred for periodic skill assessments, and a safe reporting culture should be encouraged for the sake of transparency and learning from errors. We recognize the use of technology, such as electronic health records and computerized physician order input systems, as an important technique for improving medication safety. Future directions include creating national guidelines, establishing a centralized pharmaceutical error reporting system, and fostering a safety culture inside healthcare organizations. By addressing these obstacles and capitalizing on the opportunities indicated, we may improve pharmaceutical safety and, ultimately, patient care and outcomes in Saudi Arabia. Full article

Background/Objectives: Controversy exists over the use of passive reporting systems, especially the Vaccine Adverse Event Reporting System, in risk assessment. One limitation of these systems is that adverse event (AE) reporting rates cannot be calculated without knowing the number of shots administered or prescriptions in the case of pharmaceuticals. Adverse event reporting rates can be a factor in a risk assessment, though they should not be solely relied on; they can be used to compare the relative safety profiles of different vaccine products or pharmaceuticals. This study introduces the Denominator-Adjusted Rate Estimates of Substance Adverse Events Frequency Evaluation (DARE-SAFE) method to analyze pharmacovigilance reporting rates for vaccines and common pharmaceuticals. Methods: We calculated reporting rates for the top 250 most prescribed drugs in the US Food and Drug Association (FDA) Adverse Event Reporting System and common vaccines in the Vaccine Adverse Events Reporting System. For vaccines, we used USA Centers for Disease Control (CDC) dose data and OpenVAERS reports. For pharmaceuticals, we utilized prescription data from ClinCalc and FAERS reports for 2022. Results: VAERS reporting rates varied significantly across vaccine types. COVID-19 vaccines showed a 63.0 ± 0.6 times higher rate of VAERS deaths per dose and an 18.95 ± 0.02 times higher rate of total adverse event reports per dose compared to influenza vaccines. The ratio of total VAERS reports to deaths for vaccines was 73 ± 4 to 1 (R² = 0.94). For pharmaceuticals, the ratio of total adverse event reports to deaths was 26 ± 2 (R² = 0.46), with a strong correlation between serious adverse events and deaths (ratio 9.1 ± 0.3, R² = 0.79). Conclusions: DARE-SAFE provides a standardized method for comparing reporting rates across different medical products. The observed differences between vaccines and pharmaceuticals, as well as among different vaccine types, warrant further investigation into reporting practices, actual safety profiles, and potential biases in surveillance systems. Full article

Background: Volume-based drug procurement is regarded as a pharmaceutical cost-containment measure in healthcare provision globally. The Centralized Volume-Based Drug Procurement (CVBDP) launched in March 2019 in China, also known as the ‘4+7’ policy. 11 cities, including Xi’an city in Shaanxi Province, were set up as pilots. This study aims to examine the intended and unintended impacts of the ‘4+7’ policy on the use of original and generic drugs in city-level and county-level hospitals in Shaanxi, China. Methods: The data used in this study came from the Shaanxi Drug and Apparatus Centralized Procurement Platform (SDACPP). In total, 111,999 drug procurement order records of 118 policy-related drugs (including 25 ‘4+7’ policy-list drugs and 93 alternative drugs by generic name) from April 2017 to November 2019 were included in analyses. Policy-list drugs were divided into bid-winning and non-winning drug products. The volume and the expenditure of the drugs served as the outcome variables, measured by Defined Daily Doses (DDDs) and Chinese yuan (CNY), respectively. A difference-in-differences (DID) approach was used to estimate the policy’s net effect. Results: After the ‘4+7’ policy, the volume of bid-winning, policy-list, and policy-related drugs increased. An unexpected increase in volume was observed among alternative drugs, especially original drugs in city-level hospitals. The expenditure of policy-list and non-winning drugs declined, whereas that of alternative drugs unanticipatedly increased. Changes in volume and expenditure were both greater in generic drugs and in city-level hospitals, compared to their original and county-level hospital counterparts. Conclusions: Our findings highlight the positive effects of the ‘4+7’ policy on generic drug substitution and pharmaceutical expenditure containment, which are greater in city-level hospitals. The unanticipatedly incremental volume of original drugs in city-level hospitals suggests the potential risk of the poor quality of bid-winning drugs, lower compliance with bid-winning drugs among patients, or physicians’ profit-seeking behaviors in urban areas. More regulations and supervisions for the prescription and financial incentives of physicians are needed to address these concerns. Full article

Background/Objectives: In older patients, falls constitute a significant public health concern and a major cause of hospital admission. Fall-risk-increasing drugs (FRIDs) represent a key risk factor for falls. Therefore, modifying these drugs represents an important strategy for preventing recurrent falls and further patient harm. The objective of this study was to evaluate a structured interprofessional collaboration between physicians and pharmacists on managing FRIDs in older patients who present to the emergency department (ED) after a fall. Methods: This study was performed in the ED of a tertiary care hospital. Patients who were >65 years old and presented to the ED after a fall were included. A routine care group was included between 1 March 2020 and 31 May 2020. A pharmaceutical care group was included between 1 September 2023 and 30 November 2023. In the pharmaceutical care group, a clinical pharmacist supported the physicians in identifying and managing FRIDs. Possible solutions for improving FRID prescription were discussed interprofessionally. The number of FRIDs at ED admission and discharge, as well as the number of FRID modifications, were evaluated. Results: A total of 107 patients were enrolled in each group. There were 85 patients in the routine care group and 89 patients in the pharmaceutical care group, with at least 1 FRID prescribed at ED admission (p = 0.483). At ED discharge, there were 85 patients in the routine care group and 68 patients in the pharmaceutical care group, with at least 1 FRID prescribed at (p = 0.010). There were seven FRID modifications in the routine care group compared to 125 FRID modifications in the pharmaceutical care group. Conclusions: In this study, the interprofessional collaboration between physicians and pharmacists led to a reduced number of FRIDs being prescribed and more FRID modifications in older patients at ED discharge. Further research is required to ascertain the feasibility of integrating this single intervention into a multifactorial fall prevention program. Full article

Over the past five years, the application of artificial intelligence (AI) including its significant subset, machine learning (ML), has significantly advanced pharmaceutical procedures in community pharmacies, hospital pharmacies, and pharmaceutical industry settings. Numerous notable healthcare institutions, such as Johns Hopkins University, Cleveland Clinic, and Mayo Clinic, have demonstrated measurable advancements in the use of artificial intelligence in healthcare delivery. Community pharmacies have seen a 40% increase in drug adherence and a 55% reduction in missed prescription refills since implementing artificial intelligence (AI) technologies. According to reports, hospital implementations have reduced prescription distribution errors by up to 75% and enhanced the detection of adverse medication reactions by up to 65%. Numerous businesses, such as Atomwise and Insilico Medicine, assert that they have made noteworthy progress in the creation of AI-based medical therapies. Emerging technologies like federated learning and quantum computing have the potential to boost the prediction of protein–drug interactions by up to 300%, despite challenges including high implementation costs and regulatory compliance. The significance of upholding patient-centred care while encouraging technology innovation is emphasised in this review. Full article

Background: On-demand personalized drug production is currently not addressed with large-scale drug manufacturing. In our study, we focused primarily on identifying possible active pharmaceutical ingredients (APIs) for 3D Printing (3DP) in the current healthcare setting. Methods: We conducted a retrospective cross-sectional study in the Netherlands using three different sources; community pharmacies (n = 5), elderly care homes (n = 3), and the Erasmus MC Sophia Children’s Hospital. The primary endpoint was the percentage of prescriptions of medication manipulated before administration, thereby being a candidate for 3DP. Around a million prescriptions were analyzed in our study. Results: This study shows that around 3.0% of the prescribed drugs dispensed by Dutch community pharmacies were manipulated before administration, while around 10.5% of the prescribed drugs in the Erasmus MC Sophia Children’s Hospital were manipulated prior to administration. Conclusions: With our study, we show that the most manipulated drugs come from the groups of constipation, psychopharmaceutical, cardiovascular, and anti-infectant drugs. Successful introduction of a compounded API drug by 3DP does not only rely on the API, but it also comes with an optimal balance between technical, economic as well as societal impact factors. Our study gives direction for potential future research on the introduction of 3DP of medicine in the healthcare setting. Full article

Most drugs excreted in urine are not filtered by wastewater treatment plants and end up in aquatic systems. At concentrations measured in waters, toxic effects on species have been described. Second, most of the drug consumption is attributable to primary care prescriptions. We thus present here, an ecotoxicity classification of the most sold drugs in primary care in Switzerland. Three datasets were combined: (1) surveyed ecotoxic drugs by the Swiss National Surface Water Quality Monitoring Programme and its European equivalent, (2) the top 50 drugs by sale in primary care in Switzerland, and (3) active pharmaceutical ingredient (API) concentrations in Lake Geneva and the rivers of the canton of Vaud between 2017 and 2022. We classified APIs into five categories from the safest to the least safe: (1) APIs found in concentrations (C) <10× their environmental quality standard (EQS·10⁻¹), (2) EQS·10⁻¹ < C < EQS and not listed by the Swiss or the EU Watch List, (3) EQS·10⁻¹ < C < EQS and listed, (4) C > EQS and not listed, and (5) C > EQS and listed. We obtained full ecotoxicological data for 35 APIs. Fifteen APIs were designated as safe (category (1):paracetamol, tramadol, amisulpride, citalopram, mirtazapine, metformin, gabapentin, lamotrigine, primidone, candesartan, irbesartan, atenolol, hydrochlorothiazide, ofloxacin, sulfadiazine), eleven as intermediately safe, and nine were of concern (azithromycin, ciprofloxacin, clarithromycin, sulfamethoxazole, carbamazepine, diclofenac, ibuprofen, iomeprol, iopromide). Full data were available for only one-third of the drugs most sold in primary care. Where data do exist, we observed significant differences in environmental impact among the same class of drugs. Our classification could therefore help guide doctors to adopt more eco-friendly prescriptions. Full article