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Background: Cannabis oil titration consists of quantification of the acidic precursors tetrahydrocannabinolic acid (THCA) and cannabidiolic acid (CBDA) and their decarboxylated products, the active neutral cannabinoids delta-9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD), and is recommended to ensure galenic preparation quality through gas and liquid chromatography coupled with mass spectrometry (GC-MS; LC-MS). Analyses by LC-MS and GC-MS involving derivatization allow for detection of acidic and neutral cannabinoids; on the contrary, GC-MS without derivatization determines only neutral cannabinoids due to high temperature-decarboxylation occurring in the injection system. However, it is not clear if decarboxylation is complete. Methods: Different GC-MS methods with (BSTFA: TMCS and pyridine; incubation at 60 °C for 25 min) or without derivatization and an LC-MS method were developed for cannabinoid quantification. The total Δ9-THC and CBD yield of recovery were compared between the methods by testing laboratory samples with known concentrations of THCA and CBDA (total Δ9-THC and CBD: 175–351–702 ng/mL) and real cannabis oil samples (n = 6). Results: The total Δ9-THC and CBD yield of recovery were determined using LC-MS and GC-MS with derivatization, but not using GC-MS without derivatization (decarboxylation conversion rate of about 50–60%). No high deviation (<10%) in the total neutral cannabinoid concentrations in real cannabis oil samples was noticed, probably due to the low content of acidic forms in the original galenic preparation. Conclusions: This study raised awareness about the potential underestimation of the total Δ9-THC and CBD content in cannabis oils when quantification is performed by GC-MS without derivatization. The advice for pharmacists is to perform complete decarboxylation to convert all acidic precursors in neutral cannabinoids. Full article

In the United States, 41.6% of all pregnancies are unintended. This disproportionately affects women 20 to 24 years old. The high rate of unintended pregnancy among college students is associated with a lack of or incomplete formal education on reproductive health in grade and high school. The purpose of this study was to evaluate the outcomes of health education seminars designed to reduce reproductive health knowledge gaps among college-aged students and increase their safe sex behavior (health protection/prevention). Student pharmacists offered eighteen one-hour health education programs on fertility, contraception, and emergency contraception to college student attendees via live and Zoom-based presentations. Pre- and post-program quizzes, a post-program performance evaluation, and a post-program behavior change survey were completed anonymously. The response rate was 94.8% (n = 153 attendees). Post-program quiz scores (84%) were significantly higher than pre-program quiz scores (56%, p ≤ 0.001). The greatest increases in knowledge were about sperm survival, correct condom use, and fertility windows. The two-month follow-up survey responses revealed more confidence with birth control decisions, increased awareness of emergency contraception items, increased safe sex behaviors, and increased condom usage. Students reported that the seminars were helpful for preventing future unintended pregnancies. Reproductive health knowledge gaps can be minimized, and some self-reported safe sex behaviors can be improved with health education programs implemented at a university. Full article

Background: In the UK and globally, pharmacy professionals (pharmacists and pharmacy technicians) contribute to the delivery of local and national public or population health interventions. The existing literature on pharmaceutical public health predominantly focuses on micro-level activities, primarily describing community pharmacies delivering public health interventions to individuals. There is little-known evidence on pharmacy professionals’ involvement in delivering public health interventions at meso- (e.g., organisational) and macro (national/policy) levels, nor to what extent pharmacy professionals have specialist/advanced roles within public health practice. This study specifically explored pharmacy professionals’ specialist/advanced roles within public health as well as the opportunities and barriers to career development. The analyses of this mixed-methods study makes a series of important recommendations for future action. Methods: This study included two independent cross-sectional electronic surveys for pharmacy professionals and public health professionals, a call for evidence, and two workshops to develop recommendations. Results: Pharmacy professionals (n = 128) and public health professionals (n = 54) across the UK participated in the surveys. Most of the Pharmacy Professionals respondents were female (70%), pharmacists (85%), working in primary (33%) or secondary (25%) care settings, mainly based in England (75%), and most (63%) lacked formal public health qualifications although they were involved in a diverse range of public health interventions. The public health professionals were mostly females (67%), practicing in England (58%). Both professional groups identified opportunities and barriers to pharmacy professionals’ involvement in public health. Almost half of the public health professionals respondents (44%) stated that they had a pharmacy professional working as part of their current public health teams. Eighty-seven percent of public health professional respondents (45/52) agreed that having pharmacists or pharmacy technicians specialising in public health would be beneficial or very beneficial. Most of the documents, reports, and case histories provided through the call for evidence were unpublished. The workshops generated 94 recommendation statements, highlighting collaboration and the need to acknowledge pharmacy professionals’ contributions to public health. Conclusion: The recommendations for strategic action at meso- and macro-levels included three main themes: adopting a national strategic approach to pharmaceutical public health, including improving commissioning; formalising pharmaceutical public health workforce development; and promoting further evidence-based pharmaceutical public health research and development. Full article

While pharmacy education successfully employs various methodologies including case-based learning and simulated patient interactions, providing consistent, individualized guidance at scale remains challenging in team-based learning environments. Artificial intelligence (AI) offers potential solutions through automated facilitation, but its possible utility in pharmacy education remains unexplored. We developed and evaluated an AI-guided patient case discussion simulation to enhance learners’ ability to integrate foundational science knowledge with clinical decision-making in a didactic immunology course in a US PharmD program. We utilized a large language model programmed with specific educational protocols and rubrics. Here, we present the step-by-step prompt engineering protocol as a toolkit. The system was structured around three core components in an immunology team-based learning activity: (1) symptomatology analysis, (2) laboratory test interpretation, and (3) pharmacist role definition and PPCP. Performance evaluation was conducted using a comprehensive rubric assessing multiple clinical reasoning and pharmaceutical knowledge domains. The standardized evaluation rubric showed reliable assessment across key competencies including condition identification (30% weighting), laboratory test interpretation (40% weighting), and pharmacist role understanding (30% weighting). Our AI patient simulator offers a scalable solution for standardizing clinical case discussions while maintaining individualized learning experiences. Full article

As medical devices become integral to modern healthcare, it is essential to prepare future pharmacists to counsel patients on device use and emerging therapeutic technologies. This study evaluates the impact of hands-on medical device training on pharmacy students at the University of Southern California (USC) Mann School of Pharmacy and Pharmaceutical Sciences, focusing on the level of comfort in counseling patients and retention of device-related information. Utilizing an active learning framework, this study provides insights into how experiential learning methods using medical devices enhance pharmacy students’ readiness for clinical practice. The results demonstrated significant improvement in levels of student comfort with counseling and information retention. The implementation of a hands-on training module has the potential to be adapted and applied to other courses or programs. The findings highlight the importance of integrating practical training within the pharmacy curriculum to better prepare graduates for effective patient education and support. Full article

Background/Objectives: Antimicrobial stewardship programs improve antimicrobial use and help combat antimicrobial resistance. The Infectious Disease Society of America’s (IDSA) recommended core interventions include prospective audit and feedback along with formulary restriction and preauthorization. IDSA recommends any one of these interventions be implemented in acute care hospitals to improve antimicrobial stewardship. The objective of this project was to implement a prospective audit and feedback system using selected antimicrobials at a tertiary care hospital in the United Arab Emirates as the foundation to build an antimicrobial stewardship program. Results: A total of 497 patients met the inclusion and exclusion criteria during the study period; the post-intervention group had 260 patients, and the control group had 237 patients. After the implementation of the program, a total of 186 interventions were recommended, and 76% were accepted. The length of stay, length of therapy, and days of therapy were lower in the intervention group compared to the control group (p < 0.05). There was no statistically significant difference in clinical outcome measures (e.g., 30-day readmission, 30-day all-cause mortality, 30-day emergency visit with the same infection, and 60-day readmission). Methods: This single-center quasi-experimental research was conducted from August 2023 to July 2024. A pharmacist-led prospective audit and feedback system was initiated in February 2024 after review and approval of the medical staff, in addition to formulary restrictions. Data from patients receiving the selected antimicrobial before February 2024 were collected from their charts and related medical records without any intervention; this was used by our control group. After implementation, the hospital pharmacy’s records were evaluated during the night shift to determine whether they met the inclusion criteria. The records of the eligible patients were then evaluated by the clinical pharmacist. In case of antimicrobial inappropriateness, feedback was provided to the prescriber. If the recommendation was not accepted, succeeding reviews and feedback were provided on subsequent days. The effectiveness of the intervention was measured using clinical and antibiotic use measures. Conclusions: Implementation of a pilot pharmacist-led antimicrobial stewardship program resulted in modification in antimicrobial use measures (i.e., defined daily doses of targeted antimicrobials and days of antimicrobial therapy) without an increase in length of stay or readmissions or mortality. Full article

Patients with chronic cholestatic liver diseases often experience itch and struggle with this symptom. We discuss the mechanism of itch in patients with chronic cholestatic liver diseases, such as primary biliary cholangitis (PBC) and others, and their therapies, including ileal bile acid transporter (IBAT) inhibitors. In patients with PBC, there are high serum/plasma concentrations of multiple factors, including bile salts, bilirubin, endogenous opioids, lysophosphatidic acid (LPA), autotaxin, and histamine. Bile salts, bilirubin, LPA, and autotaxin affect itch mediators in the skin and sensory nerves, while the endogenous opioid balance affects mediators in the spinal cord. Itch is sensitized by both the peripheral and central nervous systems. Both mechanisms are involved in itch in patients with chronic cholestatic liver disease. Although IBAT inhibitors have been approved for use in pediatric cholestatic conditions, such as progressive familial intrahepatic cholestasis and Alagille syndrome, IBAT inhibition seems to be a promising treatment for chronic refractory itch in patients with PBC. A traditional non-systematic review results in this narrative review. Multidisciplinary cooperation, involving hepatologists, dermatologists, and pharmacists, could provide better treatment for PBC patients suffering from refractory itch. In conclusion, we summarized the existing knowledge on itch caused by chronic cholestatic liver diseases, especially in PBC with a focus on the mechanisms and therapies. This narrative review provides the mechanisms and therapeutic options for itch in patients with chronic cholestatic liver diseases. Full article

The aim was to determine the influence of a complex intervention based on pharmacotherapeutic follow-up (PTF) and the application of therapeutic education (TE) protocols on the clinical and educational parameters of patients at cardiovascular risk (CVR) attending community pharmacies (CPs). A prospective, longitudinal, randomized, controlled clinical trial was conducted over 6 months in patients from four Spanish CPs, divided into control (CG) and intervention (IG) groups. CG patients received usual pharmacy care and IG patients received a PTF- and TE-based intervention. The sample consisted of 85 elderly patients. After pharmaceutical follow-up of the IG patients, the following results were observed: significant reductions in cardiovascular risk (CVR) (p < 0.005), blood pressure (BP) (p < 0.05), and sedentary lifestyle (p < 0.001), as well as an improved knowledge of CVR and cardiovascular risk factors (CVRFs) (p < 0.001). Target values for BP were achieved in 27.2% of patients and for triglycerides in 12.4% of patients. The PTF of the patients showed that 29.2% did not have the expected response to some treatments, while 25% had untreated pathologies and 10% had adverse reactions. The TE protocols related to the patients’ educational needs, applied individually and in conjunction with the PTF, were able to improve their lifestyle habits, their knowledge of CVR, CVRFs, and pharmacotherapy, and their clinical parameters, and, thus, the level of development of their disease Full article

Background: It is well established by research that large-scale and indiscriminate prescribing, dispensing, and use of antimicrobials drive antimicrobial resistance (AMR) endangering the health and well-being of people, animals, and the environment. In the context of low- and middle-income countries (LMICs), the prescribing of antimicrobials is often not based on biomedical rationality but involves alternative logic driven by social, cultural, and institutional factors. This paper seeks to develop a “biosocial” perspective, reflecting a unified perspective that treats the biomedical and social conditions as two sides of the same coin. Methods: This analysis is based on an empirical investigation of prescription slips that patients carry to buy drugs from the pharmacy following an outpatient department encounter with the clinician. Data collection involves mixed methods, including the quantitative analysis of the antimicrobials prescribed and a qualitative analysis of the underlying reasons for these prescriptions, as described by doctors, pharmacists, and patients. Data analysis involved triangulating quantitative and qualitative data, to develop a “biosocial” perspective, which can provide implications for the development of antimicrobial stewardship policies, particularly relevant for health institutions in low- and middle-income countries. Results: Our analysis of 1175 prescription slips showed that 98% contained antimicrobials, with 74% being broad-spectrum antimicrobials. Only 9% of cases were advised antimicrobial sensitivity testing (AST) before initiating treatment. Qualitative findings indicated that patients had poor awareness of antimicrobials and pharmacists played a crucial role in counseling. Conclusions: This study highlights that antimicrobial prescriptions in public health settings are influenced by both biomedical and social factors, supporting a biosocial perspective. Although AMS interventions are predominantly biomedical, adhering to clinical standards and best practices, this study underscores the necessity of integrating a biosocial viewpoint by incorporating the experiences of pharmacists and patient groups. Strengthening diagnostic support, patient education, and interprofessional collaboration could improve rational antimicrobial uses in low-resource settings. Full article

The University of Utah Clinical Innovation Fellowship models novel partnerships between third-party payers, clinical practices, and academia. While healthcare costs continue to increase unabated and physician burnout leads to provider shortages, this fellowship focuses on both crises by training pharmacists to establish new practices in ambulatory clinic spaces using funding provided by third-party payers. Not only does this fellowship represent a future in which pharmacists are able to address third-party payers’ need to reduce healthcare costs and clinics’ need to address provider shortages, it also successfully trained fellows to pursue jobs in ambulatory care and academia. Payers, clinics, providers and patients all expressed a high degree of satisfaction with the work of the fellows. In multiple clinics where fellows established new pharmacy services, those services led directly to new job approvals funded by the clinics themselves. The purpose of this paper is to serve as a model by which fellowship programs elsewhere can be designed, as well as to show that partnerships between ambulatory clinics, payers, and pharmacists are both sustainable and beneficial to all parties including, most importantly, the patients who receive better care for their complex chronic disease states. While this paper is descriptive in nature, work is ongoing to objectively measure the impact of the fellows on patients, providers, and third-party payers. A sampling of outcomes is presented, describing the impact of the pharmacist fellows’ efforts to improve medication management in primary care. Even with limited objective measures of success, we are able conclude that over the past 3 years, the fellowship has accomplished its aim of preparing fellows for future roles in ambulatory care, practice design, and academia while also demonstrating that a funding model aligning payers, clinics, and academia is sustainable. Full article

The role of General Practice Pharmacists (GPPs) has expanded in response to increasing demands on primary care services, particularly in managing chronic conditions. While GPPs are recognised for their contributions to medication optimisation and patient care, challenges such as role clarity, workload pressures, and confidence in clinical decision-making remain underexplored. This study aims to investigate the tasks, professional identity, confidence levels, and challenges faced by GPPs in Northern Ireland. A mixed-methods design was employed, incorporating a questionnaire distributed to GPPs across Northern Ireland. The questionnaire comprised 20 multiple-choice questions and 5 open-ended questions, focusing on demographics, tasks, confidence levels, role clarity, and professional challenges. Quantitative data were analysed using descriptive and inferential statistics, while qualitative responses underwent thematic analysis using NVIVO software. A total of 44 GPPs participated, with a majority being female and aged 34–39 years. Most participants had 4–6 years of experience as GPPs. Quantitative findings revealed significant correlations between clinical confidence and factors such as years of experience, age, and employment type. Qualitative analysis revealed key themes: clinical confidence was enhanced by training and experience, but workload pressures often limited time for patient care. Variability in role integration and the lack of public awareness were highlighted as barriers to maximising the GPP role. This study highlights the key challenges of workload distribution and role ambiguity in the GPP role. Delegating administrative tasks and developing clear frameworks for role integration could address these barriers. Additionally, targeted training programs and public education campaigns are essential to enhance the impact of GPPs in primary care. Full article

Background: The prevalence of chronic kidney disease (CKD) is rising, increasing demand for renal replacement therapy (RRT). Community pharmacies, as accessible healthcare hubs, can play a pivotal role in CKD prevention. This study aimed to develop care models for community pharmacies to optimize medication use, encourage behavior modification, and promote self-management among at-risk individuals. Methods: Conducted between June 2017 and July 2018, this study utilized an action research approach. Microalbuminuria was assessed using urine dipsticks, and pharmacists applied behavioral change and self-management support (SMS) strategies to slow CKD progression. Participants were categorized by albuminuria levels and enrolled in pharmacist-led care programs, with follow-up assessments at weeks 0 and 12. Results: Of 521 participants screened, 57% tested positive for albuminuria. For these individuals, serum creatinine testing and referrals to primary care were initiated. Self-management behavior assessment (S1) scores significantly improved (p = 0.024). Key factors associated with urine albumin levels included age < 60 years (OR = 0.44), diabetes (OR = 3.69), hypertension (OR = 2.01), BMI < 27.5 kg/m² (OR = 0.42), eGFR ≥ 60 mL/min/1.73 m² (OR = 3.34), lower systolic (OR = 0.55) and diastolic blood pressure (OR = 0.34), and fasting plasma glucose < 126 mg/dL (OR = 0.29). Conclusions: Community pharmacist-led albuminuria screening effectively supports CKD prevention and enhances self-awareness within communities. Full article

Background: Acute-on-chronic liver failure (ACLF) is a severe, rapidly progressing syndrome in patients with liver cirrhosis, often triggered by bacterial infections. Piperacillin/Tazobactam is a key antibiotic in this setting, and therapeutic drug monitoring (TDM) helps optimize its dosing. This study evaluates the impact of an interprofessional TDM strategy for Piperacillin/Tazobactam in ACLF patients in the ICU. Methods: This retrospective ICU study evaluated an interprofessional TDM approach for optimizing Piperacillin/Tazobactam dosing in critically ill ACLF patients. The team, consisting of physicians, clinical pharmacists, and staff nurses, engaged in shared decision making, collaboratively interpreting TDM results and adjusting the dosing accordingly. This study included 26 patients with ACLF who underwent initial TDM and 7 who received follow-up TDM. Piperacillin/Tazobactam dosing was modified based on TDM recommendations, with serum concentrations measured weekly. Adherence to and the implementation of interprofessional dosing recommendations were systematically analyzed to assess the impact of this approach. Results: The initial TDM showed that 30.8% of patients had Piperacillin/Tazobactam levels within the target range, while 53.8% were above and 15.4% below. The interprofessional team recommended dose reductions in seven patients, increases in three, and no change in eleven, with five requiring antibiotic modifications. At the first follow-up TDM, 20.0% reached target levels, while 80.0% remained above, with no subtherapeutic cases. The team recommended one further dose reduction and maintained dosing in four patients. All recommendations were fully implemented, demonstrating strong adherence to the collaborative protocol. Conclusions: The interprofessional TDM strategy optimized Piperacillin/Tazobactam dosing in ACLF patients with full adherence to the recommendations. This collaborative approach improves outcomes and supports global efforts to curb antibiotic resistance. Full article

Background/Objectives: Vulvovaginal candidiasis (VVC) is a common cause of vaginitis. Over-the-counter drugs are usually dispensed by pharmacy professionals to treat this condition without prior medical consultation. This study aimed at assessing the knowledge of Portuguese pharmacy professionals regarding VVC. Methods: An online questionnaire including questions about the symptoms and treatment of VVC was distributed between March and April of 2024. Results: A total of 376 professionals participated in this study. There was a significantly lower proportion of men (p = 0.007) and pharmacy technicians (p = 0.005) who correctly identified the main causative agent of VVC when compared to women and pharmacists. Only 30% of women correctly identified the number of VVC episodes in the same year they classified as complicated, but this was significantly higher (p = 0.038) than the proportion of men who identified complicated VVC (20%). Topical clotrimazole preparations were the more frequently identified medicines for the treatment of uncomplicated VVC, and fluconazole-containing medicines were the preferred choice for the treatment of complicated VVC. Conclusions: This study highlights the need to improve education and training for pharmacy professionals. By addressing these knowledge gaps, pharmacists and pharmacy technicians can provide more accurate and effective advice to patients. Full article

Background: In 2015, the Directorate General of Drug Administration (DGDA) of Bangladesh accredited model pharmacies (MPs) to enhance the quality of pharmacy services across the country. We examined the challenges and opportunities for pharmacists in MPs, and also explored the perspectives of the pharmacy stakeholders for improving good pharmacy practices (GPPs) in Bangladesh. Methods: In-depth interviews (IDIs) were conducted with graduate pharmacists (Grade A) and diploma pharmacists (Grade B) recruited from a few selected MPs that were included in a previous study. Key informant interviews (KIIs) were conducted with the government and non-government stakeholders who were involved in pharmacy regulations and practices. Trained qualitative researchers conducted IDIs and KIIs using interview topic guides under relevant themes developed by the study investigators. Results: Between February and March 2021, nine Grade A and six Grade B pharmacists and nine government and non-government stakeholders were interviewed. The key challenges, as well as demotivational factors, for Grade A pharmacists were reported to be multiple responsibilities, inadequate salary, poor social status, an unfavorable working environment, long working hours, a lack of recognition, and low respect for their profession. However, Grade B pharmacists expressed job satisfaction, primarily due to working opportunities in reputable pharmacies and learning opportunities. The stakeholders reported a high operation cost of the MPs, a shortage of trained pharmacists, poor salary structures, and a lack of public awareness about the critical roles of the pharmacists in healthcare to be challenges of retaining Grade A pharmacists at the MPs. Addressing the challenges of the pharmacists and revising compensation packages along with strengthening monitoring systems would be important for improving GPPs at the MPs. Conclusions: This study has demonstrated that specifying the roles of the pharmacists, offering competitive packages, conducive working hours, and professional recognition would be imperative for the retention of trained pharmacists at MPs. Implementing regulatory standards and monitoring performance would enhance good pharmacy practices in Bangladesh. Full article