Search Results (418)

This study investigates the accessibility of public healthcare services in Olsztyn County, a major urban center in the Warmia and Mazury region of Poland. The aim was to develop a methodological framework using Geographic Information System (GIS) tools and spatial data to assess the local availability of healthcare infrastructure. The analysis included key facilities such as hospitals, clinics, pharmacies, and specialized outpatient services. A spatial accessibility indicator was constructed to evaluate and compare access levels across municipalities. The results show a clear disparity between urban and rural areas, with significantly better access in cities. Several rural municipalities were found to have limited or no access to essential healthcare services. These findings highlight the uneven spatial distribution of medical infrastructure and point to the need for targeted strategies to improve service availability in underserved areas. The proposed methodological approach may support future studies and inform local and regional planning aimed at reducing healthcare inequalities and improving access for all residents, regardless of their location. This research contributes to the growing body of evidence emphasizing the role of spatial analysis in assessing public service accessibility and supports the development of more equitable healthcare systems at the local level. Full article

Background and Objectives: Investigating the adherence to antihypertensive medication and identifying patients with low adherence allows targeted interventions to improve therapeutic outcomes. Artificial intelligence (AI) offers advanced tools for analyzing medication adherence data. This study aimed to develop and validate several predictive models for non-adherence, using patient-reported data collected via a structured questionnaire. Materials and Methods: A cross-sectional, multi-center study was conducted on 3095 hypertensive patients from community pharmacies. A structured questionnaire was administered, collecting data on sociodemographic factors, medical history, self-monitoring behaviors, and informational exposure, alongside medication adherence measured using the Romanian-translated and validated ARMS (Adherence to Refills and Medications Scale). Five machine learning models were developed to predict non-adherence, defined by ARMS quartile-based thresholds. The models included Logistic Regression, Random Forest, and boosting algorithms (CatBoost, LightGBM, and XGBoost). Models were evaluated based on their ability to stratify patients according to adherence risk. Results: A total of 79.13% of respondents had an ARMS Score ≥ 15, indicating a high prevalence of suboptimal adherence. Better adherence was statistically associated (adjusted for age and sex) with more frequent blood pressure self-monitoring, a reduced salt intake, fewer daily supplements, more frequent reading of medication leaflets, and the receipt of specific information from pharmacists. Among the ML models, CatBoost achieved the highest ROC AUC Scores across the non-adherence classifications, although none exceeded 0.75. Conclusions: Several machine learning models were developed and validated to estimate levels of medication non-adherence. While the performance was moderate, the results demonstrate the potential of AI in identifying and stratifying patients by adherence profiles. Notably, to our knowledge, this study represents the first application of permutation and SHapley Additive exPlanations feature importance in combination with probability-based adherence stratification, offering a novel framework for predictive adherence modelling. Full article

Objective: This proof-of-concept study aimed to evaluate and compare the clinical performance of two AI language models (ChatGPT-3.5 and OpenAI o3) in answering clinical pharmacy multiple-choice questions (MCQs), benchmarked against responses from specialist clinical pharmacists in Jordan, including academic preceptors and hospital-based clinicians. Methods: A total of 60 clinical pharmacy MCQs were developed based on current guidelines across four therapeutic areas: cardiovascular, endocrine, infectious, and respiratory diseases. Each item was reviewed by academic and clinical experts and then pilot-tested with five pharmacists to determine clarity and difficulty. Two ChatGPT models—GPT-3.5 and OpenAI o3—were tested using a standardized prompt for each MCQ, entered in separate sessions to avoid memory retention. Their answers were classified as true/false positives or negatives and retested after two weeks to assess reproducibility. Simultaneously, 25 licensed pharmacists (primarily from one academic institution and several hospitals in Amman) completed the same MCQs using validated references (excluding AI tools). Accuracy, sensitivity, specificity, and Cohen’s Kappa were used to compare AI and human performance, with statistical analysis conducted using appropriate tests at a significance level of p ≤ 0.05. Results: OpenAI o3 achieved the highest accuracy (83.3%), sensitivity (90.0%), and specificity (70.0%), outperforming GPT-3.5 (70.0%, 77.5%, 55.0%) and pharmacists (69.7%, 77.0%, 55.0%). AI performance declined significantly with increasing question difficulty. OpenAI o3 showed the highest accuracy in the cardiovascular domain (93.3%), while GPT-3.5 performed best in infectious diseases (80.0%). Reproducibility was higher for GPT-3.5 (81.6%, κ = 0.556) than OpenAI o3 (76.7%, κ = 0.364). Over two test rounds, GPT-3.5’s accuracy remained stable, whereas OpenAI o3’s accuracy decreased from 83.3% to 70.0%, indicating some variability. Conclusions: OpenAI o3 shows strong promise as a clinical decision-support tool in pharmacy, especially for low- to moderate-difficulty questions. However, inconsistencies in reproducibility and limitations in complex cases highlight the importance of cautious, supervised integration alongside human expertise. Full article

Background: This study investigated the prevalence and predictors of burnout among medical students at “Dunărea de Jos” University of Galați, Faculty of Medicine and Pharmacy. Methods: Burnout was measured using the School Burnout Inventory-U 9 (SBI-U 9), and potential predictors, including social media addiction (Bergen Social Media Addiction Scale—BSMAS), procrastination, age, gender, year of study, admission grade, last annual grade, hobbies, achievements, close friends, and relationship status, were assessed using appropriate instruments. Correlation and hierarchical multiple regression analyses identified predictors of burnout. Mediation analysis tested procrastination as a mediator between BSMAS and burnout, while moderation analysis examined whether procrastination moderated this relationship. Results: Social media addiction was an independent predictor of burnout. While younger age was correlated with higher burnout, it was not a significant predictor in the multivariate model. Procrastination did not significantly mediate the link between social media addiction and burnout but significantly moderated it. The effect of social media addiction on burnout was stronger for students with lower levels of procrastination. Conclusions: The study shows increased susceptibility to burnout among younger students and identifies social media addiction as a key risk factor. Procrastination moderates this relationship, indicating the need for interventions targeting both digital habits and time management in medical education. Full article

Background and Objectives: Early detection of cognitive decline (CD) is crucial for managing dementia risk factors and preventing disease progression. This study pursues two main objectives: (1) to review existing cognitive screening practices implemented in community pharmacy settings and (2) to characterize the cognitive profile of individuals eligible for screening in this context. Materials and Methods: This study was conducted in two phases. First, a scoping review of cognitive screening tools used in community pharmacies was carried out following PRISMA-ScR guidelines. Second, a cross-sectional study was performed to design and implement a CD screening protocol, assessing cognitive function. Data collection included demographic and clinical variables commonly associated with dementia risk. Decision tree analysis was applied to identify key variables contributing to the cognitive profile of patients eligible for screening. Results: The scoping review revealed that screening approaches differed by country and population, with limited pharmacy involvement suggesting implementation barriers. Cognitive screening was conducted in 18 pharmacies in Valencia, Spain (1.45%), involving 286 regular users reporting Subjective Memory Complaints (SMC). The average age of participants was 71 years, and 74.8% were women. According to the unbiased Gini impurity index, the most relevant predictors of CD—based on the corrected mean decrease in corrected impurity (MDcI), a bias-adjusted measure of variable importance—were age (MDcI: 2.60), internet and social media use (MDcI: 2.43), sleep patterns (MDcI: 1.83), and educational attainment (MDcI: 0.96). Simple decision trees can reduce the need for full screening by 53.6% while maintaining an average sensitivity of 0.707. These factors are essential for defining the profile of individuals who would benefit most from CD screening services. Conclusions: Community pharmacy-based detection of CD shows potential, though its implementation remains limited by issues of consistency and feasibility. Enhancing early dementia detection in primary care settings may be achieved by prioritizing individuals with limited internet and social media use, irregular sleep patterns, and lower education levels. Targeting these groups could significantly improve the effectiveness of CD screening programs. Full article

Background: Due to their participation in patient care, pharmacists frequently face various ethical decisions that must be made. Every day, pharmacists encounter ethical challenges in any pharmaceutical workplace. This study aims to assess the attitude and awareness among pharmacy students and pharmacists regarding general and professional ethics. Methods: This study was cross-sectional, using an interview-based questionnaire. Pharmacy students from Yarmouk University volunteered to approach other pharmacy students and pharmacists to complete the questionnaire using a convenient sampling method. Results: A total of 1737 pharmacy students and pharmacists participated in this study. Among the 691 participants who are currently practicing pharmacists, 549 (79.4%) reported working in a community pharmacy. About half of the pharmacy students (53.6%) had studied a course in ethics, while 110 (15.9%) of the pharmacists had not. While students and pharmacists have shown significantly different attitudes, less than 20% of the participants demonstrated a high level of awareness regarding the pharmacy code of ethics. On the other hand, more than 60% of pharmacy students and practicing pharmacists concurred that they might permit others to carry out the duties of a pharmacist. Surprisingly, the data revealed that student pharmacists performed better than practicing pharmacists, highlighting that students appreciate the principles of professionalism and that exposure to a work environment can help modulate negative behavior and beliefs. Conclusions: These findings underscore the need for ongoing ethical education and training for both pharmacy students and practicing pharmacists to ensure that everyone in the field upholds a high standard of moral behavior in patient care. Full article

Background: Liberia is among the 30 countries with a high burden of tuberculosis worldwide. Health sciences students, who are future health professionals, have essential roles in curtailing the spread of TB. This study aims to evaluate the knowledge, attitude, and practice (KAP) of tuberculosis (TB) among health sciences students. Methods: This study used a quantitative cross-sectional design to assess Medical, Pharmacy, and Public Health students at the University of Liberia’s KAP regarding TB using a modified previously used self-administered questionnaire reviewed by subject experts from 1 April 2025 to 23 April 2025. SPSS 26 was used for analysis. Descriptive statistics, Mann–Whitney, Kruskal–Wallis, and multivariate logistic regression tests were used for analysis. Results: In total, 630 students participated, of which 51.7% were females, 83% were aged 24 or above, 81.6% were single, and 96.7% had never smoked. The KAP levels were 65.9%, 97.3%, and 94.8%, respectively. Higher TB knowledge was significantly associated with being enrolled in the Medical program (OR = 2.20, 95% CI: 1.28–3.76, p < 0.05), being in year 4 and 5 (OR = 1.79, 95% CI: 1.09–2.98, p < 0.05; OR = 2.28, 95% CI: 1.08–4.78, p < 0.05), being unemployed (OR = 1.58, 95% CI: 1.09–2.31, p < 0.05), and having personal acquaintance with individuals diagnosed with TB (OR = 1.64, 95% CI: 1.11–2.42, p < 0.05). Conclusions: The knowledge level among students was good. They had a positive attitude, and their practice levels were good. However, gaps remain in understanding latent TB and proper disinfection methods for TB-related materials. Strengthening the health curriculum to address these specific knowledge gaps is recommended to better align students’ knowledge with their attitudes and practices. Full article

Background: Furosemide is a loop diuretic used extensively to treat adult and pediatric patients. In some hospitals, furosemide oral liquids are not available in stock, thus necessitating the extemporaneous preparation of the drug. This study evaluates the stability of on-the-spot formulations of furosemide oral suspensions from crushed tablets evaluated in various vehicles: Dextrose 50%, Dextrose 70%, Ora-Sweet, and Ora-Plus over 60 days. This examination was prompted by the frequent shortage of certain excipients in the hospital, leading to the need to switch to Dextrose 50% or Dextrose 70% when Ora-Sweet and Ora-Plus are out of stock. Methods: The extemporaneous furosemide oral suspensions were prepared following the same compounding method used in the pharmacy. The suspensions were maintained at 4 °C in the refrigerator and assessed immediately and later, on days 7, 14, 30, and 60. The assessed parameters included visual appearance, redispersion time, sedimentation volume, and pH levels for stability analysis. We also examined the drug content, dissolution of the suspension, and microbiological stability. Results: Initial examinations indicated that Dextrose 50% and Ora-Plus maintained pH levels and stable appearances, while significant changes, mainly in appearance and redispersion time, indicated the instability of Dextrose 70%. Ora-Sweet showed fluctuations but stabilized by day 30. Dissolution studies demonstrated that Ora-Plus had dissolution characteristics superior to the other formulations, while Dextrose 50% showed declining dissolution percentages over time. Overall, the Ora-Plus vehicle showed superior stability (60 days), followed by Ora-Sweet (30 days), while Dextrose 70% and Dextrose 50% showed shorter stability durations of 14 and 7 days, respectively. The microbiological test results showed no microbial growth. Conclusions: This study demonstrates that the vehicle used in extemporaneous furosemide suspensions critically affects their stability and performance. Ora-Plus emerged as the most suitable vehicle, maintaining physical, chemical, and microbiological stability over 60 days, with consistent pH, redispersion, and dissolution behavior. Ora-Sweet showed intermediate stability (30 days), while Dextrose 50% and 70% exhibited early instability—7 and 14 days, respectively—marked by sedimentation, poor redispersibility, and declining drug release. These findings underscore the importance of vehicle selection and regular stability monitoring in compounded formulations to ensure therapeutic reliability and patient safety. Full article

The global sleep aids market has grown significantly due to rising stress and increased awareness of sleep’s importance. Melatonin, available in the EU as a prescription or over-the-counter medicine, depending on the country, is also permitted in dietary supplements with country-specific limits. Recent reports indicate concerning levels of excessive melatonin in EU dietary supplements, necessitating accurate quantification methods. We developed and validated, by applying accuracy profiles, ISO17025-compliant, rapid ultra-high performance liquid chromatography (UHPLC) methodologies coupled with either diode array detection (DAD) or high-resolution accurate mass spectrometry (HRAM MS). The cost-effective UHPLC-DAD method is suitable for medicines and most dietary supplements, except those more complex herbal matrices containing passionflower, hop, hemp, lime tree or lavender or their extracts, where UHPLC-HRAM MS is recommended due to selectivity issues of the DAD methodology. To demonstrate the applicability, we analyzed 50 dietary supplements claiming to contain melatonin—25 from legal supply chains and 25 from suspicious sources claiming therapeutic melatonin content. Our findings confirmed previous reports of high melatonin content in online products, especially when purchased through rogue internet pharmacies. Moreover, 12% of legal supply chain samples violated current legislation through unauthorized health claims or contained at least triple the melatonin amount permitted in Belgium. This research provides reliable analytical methods for regulatory bodies and confirms the circulation of non-compliant melatonin-containing dietary supplements in the EU market, even in the legal supply chain. Full article

The tomato (Solanum lycopersicum L.) is one of the most consumed crops worldwide and a source of antioxidants. Given the role the latter play against oxidative stress and free radical-related diseases, enhancing tomato bioactive compound production would be appealing for a wide range of applications in the fields of nutrition, pharmacy, and biotechnology. This study explores a sustainable and innovative approach: the modulation of specific light spectra to boost the production of bioactive compounds in tomatoes (cultivar ‘Microtom’). We investigated how three light regimes—white fluorescent (FL), full-spectrum (FS), and red-blue (RB)—influence the accumulation of polyphenols and other key nutraceuticals during plant growth. Our findings reveal that full-spectrum (FS) light significantly enhances the levels of polyphenols, flavonoids, tannins, ascorbic acid, and lycopene in tomato fruits, compared to those grown under RB or FL light. Interestingly, fruits from RB light-grown plants showed the highest carotenoid concentrations and antioxidant capacity. These results suggest that light quality actively modulates the expression of key enzymes in the phenylpropanoid and flavonoid biosynthetic pathways, shaping each fruit’s unique metabolic fingerprint. Cluster analysis confirmed that RB, FL, and FS conditions lead to distinct polyphenolic profiles, each with notable health-promoting potential. Our results highlight a promising avenue: tailoring light environments to enhance the functional value of crops, bridging agriculture, nutrition, and biomedicine in a sustainable way. Full article

Background: Rural communities in the United States experience significant barriers in accessing healthcare, including inadequate numbers of providers and local healthcare facilities. These barriers are exacerbated during seasons with high rates of respiratory diseases when rural clinics and providers may be overwhelmed. When mild, many of these respiratory diseases may be managed effectively in alternate settings, including community pharmacies. Investigators interviewed pharmacists in Washington State to explore the capacity of pharmacists and pharmacies to provide test-to-treat services for COVID-19, influenza, and strep throat. Methods: A qualitative study design was used to conduct key informant interviews with pharmacists who precepted student pharmacists from a local university. Twenty interviews were conducted, transcribed, and qualitatively evaluated to identify themes. The 5 A’s of Access were utilized as a theoretical framework. This framework describes five domains of access, including affordability, availability, accessibility, accommodation, and acceptability. Results: Qualitative analysis identified several themes that described the benefits of offering test-to-treat services in rural communities, such as reducing geographical barriers to accessing care, reducing wait times for patients, and reducing the number of patients seeking higher levels of care for basic treatments. Barriers to offering test-to-treat services identified by pharmacist participants included difficulties with receiving payment for services, challenges with adequate staffing, and the lack of awareness among many people in rural communities that pharmacies offer test-to-treat services. Conclusions: Rural communities experience challenges with the limited capacity of healthcare providers to meet the needs of patients in their communities. The results of this qualitative analysis may be useful to pharmacists in U.S. states where collaborative drug therapy agreements or collaborative practice agreements allow the provision of test-to-treat services. By providing test-to-treat services, pharmacists can increase access to care for rural patients and alleviate the burden of offering these services from other healthcare providers. Full article

Background: Self-medication is the use of medicinal products to treat self-diagnosed disorders or symptoms without the prescription or supervision of a healthcare professional. There is a lack of data about self-medication knowledge, attitudes, and practices among pharmacy undergraduates in Malaysia. This study assessed the knowledge, attitudes, and practices among undergraduate pharmacy students in Penang regarding self-medication. Method: A descriptive cross-sectional study was conducted using a self-administered, web-based survey (Google Forms), which was completed and responded to by 203 undergraduate pharmacy students from Penang, Malaysia, between October and December 2023. Descriptive statistics were used to summarize the socio-demographic characteristics of the participants. Associations between the socio-demographic characteristics of the participants and the knowledge, attitudes, and practices regarding self-medication were assessed using a chi-square test. Regression analyses were carried out to determine whether the socio-demographic characteristics of the participants were associated with practices of self-medication. Results: A total of 203 of the undergraduate pharmacy students completed the questionnaire. More than half of the participants’ age ranged between 19 and 21 years old, the majority were females (77.3%), and 31.5% of the participants had family members employed in the healthcare sector. Most respondents showed good knowledge in a variety of domains: 97.5% acknowledged the potential for drug interaction with other medications, indicating a high awareness of proper self-medication practices. A positive attitude was found regarding participants’ attitudes toward self-medication, and 65.5% practiced self-medication, primarily for treating minor illnesses (75.9%). Common conditions included fever (83.3%), cough/cold/flu (76.8%), and headache (71.4%). Reasons for not self-medicating included the absence of illness (20.2%), lack of knowledge/prior experience (19.2%), and fear of using the wrong medication (18.7%). Only academic year level was the predictor of practicing self-medication within the last six months among the participants. Conclusions: Generally, the participants possessed good knowledge and positive attitudes toward self-medication. The study revealed no significant associations between demographic characteristics and knowledge or attitudes. Insights from this research contribute to understanding self-medication practices among pharmacy students in Penang, informing potential interventions to promote responsible self-medication practices. Full article

Hands-on continuous glucose monitoring (CGM) training is yet to be integrated intentionally into most pharmacy curricula. The objective of this study was to examine pharmacy students’ perceptions of receiving hands-on CGM training as part of their core therapeutics in diabetes. Anonymous, voluntary pre-post surveys were administered to two cohorts of 3rd-year pharmacy students from a public pharmacy school in Southern California. Pharmacy students from other class levels were excluded. The surveys, consisting of Likert scale and open-ended questions related to different aspects of CGM, were administered via a web-based learning management system. Descriptive analyses were utilized to summarize the data. In total, 84 (98%) and 79 (92%) students completed the pre- and post-activity surveys, respectively, with an average of 12.5 days of CGM wear. After receiving the CGM training, 94% of the students recommended the integration of hands-on CGM training into the PharmD curriculum. In addition, the number of students who felt confident coaching patients on CGM use more than doubled from 30% to 85%, with 73% reporting added benefits of improved personal health behaviors. In conclusion, pharmacy students’ perceptions of integrating hands-on CGM education as part of their core curriculum were largely positive with added benefits of self-care. Full article

Background/Objectives: Existing patient information leaflets (ePILs), mandated by the FDA to accompany new prescriptions, are difficult to read and understand due to their complexity and poor visual design, especially for populations with low health literacy and low English proficiency. In this study, we developed infographic-based PILs (iPILs) with a concise question-and-answer format, emphasizing essential information, as specified by the FDA. This study compared iPILs and ePILs using the 5C factors: comprehension, cosmetics, convenience, content, and credibility, as perceived by English-speaking and Spanish-speaking populations. Methods: This multicenter, experimental survey study assessed the 5C factors. English and Spanish-speaking adults on ≥1 chronic medication were recruited from community pharmacies in California (CA) and Illinois (IL). They were stratified to review either an ePIL or an iPIL for one of four common medications. They completed a Medication Knowledge Quiz (MKQ) to show their comprehension using six open-ended questions. Subsequently, they received both PIL versions and answered preference questions about the 4C and media format and, lastly, about demographic and health literacy questions. Results: A total of 235 participants completed the surveys at three sites (CA-English, CA-Spanish, and IL-English), with differing participant characteristics. The CA-Spanish participants scored the lowest on health literacy and the number of health conditions. The MKQ scores for those using the iPILs were significantly higher than for those using the ePILs across all groups. They significantly correlated with health literacy results for the ePILs (r = 0.394, p < 0.001). The participants preferred the iPILs over the ePILs for four of the C factors, barring one content question. Regardless of age, printed formats were preferred (64.7%)—alone or with digital formats (21.3%)—over digital formats alone (3.4%). Overall, 79.1% of the participants preferred iPILs, 11.9% preferred ePILs, and 8.9% preferred either version. Conclusions: The infographic-based patient information leaflets (iPILs) were easier to read, navigate, and understand, making them more accessible to individuals with varying levels of health literacy. Infographic-based leaflets outperformed existing ones in user comprehension and were preferred due to their simple layout, ease of navigation, and helpfulness. Full article

The objective was to evaluate the growth in pharmacy student performance in entrustable professional activity (EPA) assessments across the experiential curriculum based on preceptor assessments on an entrustment–supervision (ES) scale. This retrospective cohort study used assessments based on the 2016 American Association of Colleges of Pharmacy Core EPAs and an expanded ES scale during introductory and advanced pharmacy practice experiences (IPPEs/APPEs) in the third and fourth professional years from fall 2020 to fall 2023. The primary outcome was the change in ES level, assessed by preceptors over time. The secondary outcomes were growth rates across types of experiences, training environments, and experience order. A conditional growth curve model and ordinal mixed effects model were used to demonstrate discrete entrustment decisions. A total of 509 students received 12,426 assessments by 557 preceptors. Raw ES levels and unconditional growth curves for EPA show increases in entrustability from years P3 to P4. Comparing care settings, there was lower entrustment in inpatient than outpatient settings and at academic medical centers than other settings. There were no significant differences in ES levels regardless of which IPPE was taken first. However, when the first APPE was an inpatient medicine experience, ES levels across APPEs for EPA 3 were higher when compared to ambulatory care as the first APPE, and they were higher for EPA 5 when compared to community pharmacy as the first APPE. Paired with ES scales, EPAs can be integrated into pharmacy experiential curricula to demonstrate longitudinal growth in student entrustment. Full article