Hospital Pharmacy最新文献

{"title":"Impact of Pharmacist-Led Bedside Medication Education and Nursing Workflow Enhancements on HCAHPS Medication Communication Scores: A Pre-Post Implementation Quality Improvement Study.","authors":"Kyle Ames, Nadine Elnagaar, Jonida Miraka","doi":"10.1177/00185787261490063","DOIUrl":"10.1177/00185787261490063","url":null,"abstract":"<p><strong>Objective: </strong>The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey evaluates whether patients understand the purpose and potential side effects of newly prescribed medications. These measures affect patient experience metrics and may influence Centers for Medicare & Medicaid Services (CMS) reimbursement. Prior studies have suggested pharmacist-led counseling may improve medication-related HCAHPS outcomes.</p><p><strong>Methods: </strong>This pre-post quality improvement initiative was conducted across 19 inpatient units at an 897-bed community hospital. Four units with historically lower side-effect communication scores received pharmacist- and student pharmacist-led bedside medication education (BME) for newly initiated medications. Counseling addressed medication indication, common adverse effects, and teach-back. Completed education was documented on patient room whiteboards to notify nursing staff. Concurrently, all inpatient units implemented an electronic medication administration record (eMAR) enhancement that incorporated medication side-effect prompts into nursing workflows. Average unit-level HCAHPS Medication Communication scores from January through July 2024 and January through July 2025 were compared using a paired <i>t</i>-test.</p><p><strong>Results: </strong>During the 7-month intervention period, 1952 HCAHPS survey responses were received. The four targeted units completed 2503 BME encounters covering 3162 medications. Commonly discussed medication classes included anti-infectives (n = 1359; 43%), anticoagulants (n = 1304; 41.2%), diuretics (n = 402; 12.7%), and corticosteroids (n = 97; 3.1%). Across 19 inpatient units (n = 19), mean Medication Communication scores increased from 52% pre-intervention to 58% post-intervention, representing a mean increase of 6.08 percentage points (95% CI, 2.34-9.81; <i>P</i> = .003). Indication scores increased from 70.0% to 74.5%, and side-effect scores increased from 40.4% to 45.3%. Units receiving both BME and eMAR enhancements (n = 4) demonstrated increases of 1.3% and 5.6% in indication and side-effect scores, respectively. Units receiving only the eMAR enhancement (n = 15) demonstrated increases of 7.9% and 4.3%, respectively.</p><p><strong>Conclusions: </strong>Combining pharmacist-led bedside counseling with eMAR-supported nursing workflows was associated with a statistically significant increase in HCAHPS Medication Communication performance. Pharmacist involvement appeared particularly beneficial for side-effect communication, while eMAR enhancements supported broader improvements in medication indication education. These findings suggest that combined personnel- and workflow-based strategies may strengthen patient medication education and experience metrics.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787261490063"},"PeriodicalIF":0.9,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Operational Workflows and Decision Making Processes in Hospital Pharmacy Services During Drug Shortages: A Scoping Review.","authors":"Tuan-Chin Ong, Ernieda Hatah","doi":"10.1177/00185787261489688","DOIUrl":"https://doi.org/10.1177/00185787261489688","url":null,"abstract":"<p><strong>Background: </strong>Drug shortages significantly impact hospital pharmacy services, patient care, and operational efficiency. Although causes and prevalence are well documented, evidence on operational workflows and decision making processes in shortage management remains fragmented.</p><p><strong>Objective: </strong>This scoping review aimed to characterise the profile of drug shortages and map the operational workflow processes and decision making pathways used by hospital pharmacy personnel to manage drug shortages, including operational strategies, communication practices, and policy implementation.</p><p><strong>Methods: </strong>Eligible sources included primary empirical research, conference papers, conference abstracts or proceedings with sufficient methodological detail, and dissertations with accessible full text empirical findings involving hospital pharmacy settings. Only English language studies were included. Ovid MEDLINE, Scopus and Web of Science were searched from database inception to 23 February 2026. Extracted data included study characteristics, healthcare setting, shortage type, operational workflow processes, decision pathways, communication strategies and guiding policies.</p><p><strong>Results: </strong>Of 1053 records identified, 31 studies were included, predominantly from high income settings. Drug shortages commonly involved essential and injectable medicines and were associated with treatment delays and service disruption. Causes were multifactorial, including manufacturing failures, supply chain inefficiencies, economic constraints and external shocks. Management activities were synthesised into three interconnected phases: (1) detection and assessment, (2) response and strategies and (3) mitigation and evaluation. Key strategies included procurement optimisation, inventory control, therapeutic substitution, allocation prioritisation and interfacility redistribution, supported by communication systems.</p><p><strong>Conclusions: </strong>Drug shortage management is a complex process that extends beyond inventory control and requires coordinated clinical, operational and governance responses. The proposed workflow framework provides a structured but adaptable representation of the shortage management process that may inform responses across different healthcare settings. Future studies should evaluate the feasibility and applicability of the framework across diverse settings and examine the potential role of predictive analytics and inventory management supported by artificial intelligence (AI) in strengthening early warning capabilities and preparedness.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787261489688"},"PeriodicalIF":0.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13650060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial Stewardship and Financial Outcomes Following Implementation of an Infectious Diseases Pharmacist Team at a Community Hospital.","authors":"Justin M Casalini, Riley Steenhoek, Bert Iaderosa, Emily Perry, Lisa M Richter","doi":"10.1177/00185787261485531","DOIUrl":"10.1177/00185787261485531","url":null,"abstract":"<p><strong>Purpose: </strong>Utilizing an antibiotic stewardship program (ASP), antibiotic use can be enhanced by pharmacists. However, no studies evaluate ASP implementation outcomes through incorporation of an infectious diseases (ID) pharmacist team at a community hospital. This evaluation aimed to: (1) determine the net return of the ID pharmacist team implementation through an antibiotic cost-avoidance counterfactual estimate; (2) evaluate usage trends of carbapenems, fluoroquinolones, and total antimicrobial use (AU) which encompassed all antibiotics, antivirals, and antifungals; (3) assess healthcare facility-onset <i>Clostridioides difficile</i> infection (HO-CDI) rates pre- and post-implementation of a 0.6 full-time equivalent (FTE) ID pharmacist team.</p><p><strong>Methods: </strong>Single-site, retrospective, descriptive evaluation which consisted of adult patients (≥18 years) who received antibiotic, antiviral, or antifungal administrations or were diagnosed with HO-CDI during the study periods. The ID pharmacist team was implemented in September 2022. The pre-implementation period data for outcome (1) was collected from January 1, 2018, to December 31, 2020. The pre-implementation period data for outcomes (2) and (3) was collected from January 1, 2019, to December 31, 2020. The post-implementation period data for all outcomes was collected from January 1, 2023, to December 31, 2025. Patient-level data was not included. Descriptive statistics were used for data analysis.</p><p><strong>Results: </strong>The antibiotic cost-avoidance counterfactual estimate yielded an estimated net return of ~$323K for the implementation of the ID pharmacist team (~$639K avoided against ~$316K invested). Total AU decreased by 11.6% (-72.2 days of therapy (DOT)/1000 days present). Carbapenem use decreased by 75.6% (-27.6 DOT/1000 days present) and fluoroquinolone use decreased by 57.9% (-18.3 DOT/1000 days present). The incidence rate of HO-CDI per 1000 patient days decreased by 63% (incidence-rate ratio (IRR) 0.37; 95% CI [0.20-0.70]).</p><p><strong>Conclusion: </strong>Findings display a positive net return for the implementation of the ID pharmacist team based on an antibiotic cost-avoidance counterfactual estimate. There was a decrease in total AU and utilization of high-risk <i>Clostridioides difficile-</i>causing antibiotics. A lower incidence rate of HO-CDI was observed. Results could be associated with antimicrobial stewardship (AMS) efforts correlated with implementation of the ID pharmacist team.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787261485531"},"PeriodicalIF":0.9,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Prolonged Length of Stay and Perioperative Antibiotic Use Patterns in General Surgery: A Single-Centre Observational Study.","authors":"Jian Wan Lee, Ann Gie Ong, Rubiah Binti Mohd Dayaon, Sarmukh Singh Charanjit Singh, Pei Shi Tan, Nur Amalina Binti Abd Halim, Jing Tong Tai, Mohd Firdauss Bin Osman","doi":"10.1177/00185787261485529","DOIUrl":"10.1177/00185787261485529","url":null,"abstract":"<p><strong>Background: </strong>Prolonged length of stay (LOS) is a key indicator of surgical quality, efficiency of care, and resource utilization. This study aimed to identify predictors of prolonged LOS and evaluate perioperative antibiotic use patterns among general surgical patients.</p><p><strong>Methods: </strong>This prospective observational study was conducted at a Malaysian general hospital between January and October 2023. Adult patients undergoing elective or emergency general surgical procedures were consecutively enrolled. Prolonged LOS was defined as total hospitalization exceeding the cohort median (>3 days). Multivariate logistic regression was used to identify independent predictors, with full model diagnostics evaluated.</p><p><strong>Results: </strong>Among 405 patients, 35.8% experienced prolonged LOS. Gastrointestinal (GI) surgery was the strongest independent predictor of prolonged stay (adjusted odds ratio [AOR] 85.76, 95% CI: 10.94-672.34). Other independent predictors included C-reactive protein (CRP) testing (AOR 5.03, 95% CI: 1.99-12.69), positive culture and sensitivity (C&S) results (AOR 2.52, 95% CI: 1.22-5.23), longer operative duration (AOR 1.02 per minute, 95% CI: 1.01-1.03), and greater intraoperative blood loss (IBL) (AOR 1.00 per mL, 95% CI: 1.00-1.01). In contrast, intraoperative cefazolin use (AOR 0.08, 95% CI: 0.02-0.39) and absence of postoperative antibiotics (AOR 0.41, 95% CI: 0.21-0.79) were favourable markers associated with shorter hospitalization.</p><p><strong>Conclusions: </strong>Prolonged LOS in general surgery is primarily driven by disease severity and surgical complexity. Adherence to guideline-recommended surgical antimicrobial prophylaxis and the absence of need for postoperative antibiotics are favourable markers of uncomplicated recovery, supporting health system efficiency and antimicrobial stewardship goals.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787261485529"},"PeriodicalIF":0.9,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Retrospective Cross-Sectional Study With Cost and Predictive Analysis of Inappropriate Proton Pump Inhibitor Prescribing at a Tertiary Care Oncology Hospital.","authors":"Ramsha Abid, Qasim Khan, Muhammad Junaid Hassan Sharif, Omar Akhlaq Bhutta, Ghulam Mujtaba, Sajjad Ullah, Muhammad Ashfaq","doi":"10.1177/00185787261482133","DOIUrl":"10.1177/00185787261482133","url":null,"abstract":"<p><strong>Background: </strong>PPIs are among the most commonly prescribed drugs worldwide. In cancer treatment settings, they are often used preventively and to manage gut complications. Nonetheless, the issue of inappropriate prescribing continues to persist.</p><p><strong>Objectives: </strong>The aims and objectives of the study were to assess the appropriateness of the prescribing of PPIs in cancer patients as recommended by AGA and determine the predictors and financial burden of irrational use and adherence to deprescribing.</p><p><strong>Methods: </strong>A research study was conducted at cancer hospital, Peshawar, Pakistan as a retrospective cross-sectional study. A total of 200 adult patients suffering from cancer were subjected to evaluation between February and August 2023 who were taking PPIs. According to the AGA Best Practice Advice, prescriptions were assessed for indication, dose, frequency, and duration. The analysis also included deprescribing practices. The study employed chi-square and multi-variate logistic regression.</p><p><strong>Results: </strong>Over a quarter (27%) of the prescriptions were justified for indications supported by guidelines and overall rational prescribing was seen in only 1 in 8 (12.5%) cases. Documentation of indications was available in 50.5% and was the strongest predictor of rational use (OR 6.23; 95% CI 2.06-18.91; <i>P</i> = .001). Proper prescription practices were also associated with increasing age (OR 1.048, <i>P</i> = .01) and inpatient status (OR 3.87, <i>P</i> = .009). Irrational prescriptions were associated with significantly greater capsule counts and cost (PKR 564.00 vs PKR 292.60, <i>P</i> = .001). Minimal adherence was seen with no case meeting the key criteria of discontinuation therapy or dose reduction.</p><p><strong>Conclusion: </strong>Oncology patients frequently receive inappropriate PPI prescribing, that is, not aligned with guideline-recommended deprescribing practices. To ensure more rational medication use, enhanced indication documentation, regular medication reviews, and structured deprescribing strategies are essential to reduce costs and minimize risk for patients.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787261482133"},"PeriodicalIF":0.9,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning and Explainable AI for Predicting Survival and Mortality in People Living With HIV on Antiretroviral Therapy: A Secondary Analysis of the ACTG-175 Trial Dataset.","authors":"Kannan Sridharan, Gowri Sivaramakrishnan","doi":"10.1177/00185787261482139","DOIUrl":"10.1177/00185787261482139","url":null,"abstract":"<p><strong>Background: </strong>Identifying reliable predictors of mortality and survival in people living with HIV (PLWH) is essential for personalized risk stratification and treatment optimization. This study employed machine learning (ML) and explainable artificial intelligence (XAI) to identify key prognostic factors and develop predictive models for overall survival and mortality in a large PLWH cohort.</p><p><strong>Methods: </strong>We analyzed data from 2139 patients from the AIDS Clinical Trials Group Study 175. For time-to-event analysis, we implemented Cox Proportional Hazards, Random Survival Forest, and Cox Elastic-Net models. For mortality prediction, we employed Elastic Net, Random Forest, and Bayesian Additive Regression Trees (BART). Models were trained on 70% of the data and validated on the remaining 30%. SHapley Additive exPlanations (SHAP) analysis was applied to the best-performing models for interpretability. Model performance was evaluated using C-index, AUC-ROC, accuracy, sensitivity, specificity, and calibration metrics with 95% confidence intervals (CI). No external validation was performed.</p><p><strong>Results: </strong>The Cox Proportional Hazards model demonstrated the best survival prediction performance (C-index: 0.758, 95% CI: 0.723-0.784; 1-year AUC: 0.885, 95% CI: 0.849-0.934), while Elastic Net was optimal for mortality prediction (AUC: 0.751, 95% CI: 0.712-0.793; accuracy: 0.793, 95% CI: 0.758-0.825). CD4 count at 20 weeks consistently emerged as the most influential predictor across all models, with mean absolute SHAP values of 1.745 for survival and 0.129 for mortality. Treatment-related variables, including off-treatment status and specific antiretroviral therapy (ART) regimens, were also consistently important predictors. Symptomatic status showed strong negative contributions (81% for survival, 81% for mortality), while non-White race paradoxically demonstrated protective effects (73% positive contributions). BART demonstrated comparable performance (AUC: 0.743, 95% CI: 0.695-0.785) with excellent calibration (calibration slope: 0.895).</p><p><strong>Conclusion: </strong>Machine learning models, particularly Elastic Net and Cox Proportional Hazards, effectively predict mortality and survival in PLWH, with immunological response, treatment-related factors, and clinical presentation emerging as the dominant predictors. These findings support the potential of ML and XAI for personalized risk stratification in HIV care, emphasizing the critical importance of optimizing ART regimens, ensuring treatment adherence, and addressing modifiable risk factors to improve long-term outcomes.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787261482139"},"PeriodicalIF":0.9,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Transitions of Care: The Impact of Pharmacist-Led Discharge Interventions on Readmissions and Healthcare Costs.","authors":"Omar El Khatib, Wasim S El Nekidy, Emna N A Abidi, Fatima AlSalama, Noor Isam, Regina Aspe Velasco, Sara AlJabi, Joanna Saleh","doi":"10.1177/00185787261470576","DOIUrl":"10.1177/00185787261470576","url":null,"abstract":"<p><strong>Purpose: </strong>Medication discrepancies at hospital discharge contribute to readmissions and adverse outcomes. Although national groups endorse pharmacist-led discharge medication reconciliation, implementation varies. We examined the effect of pharmacist-led discharge medication reconciliation on 30-day hospital readmission odds and financial outcomes after launching a transitions-of-care discharge service at our quaternary medical center.</p><p><strong>Methods: </strong>This retrospective observational study evaluated discharged in-patients who received pharmacist-led discharge medication reconciliation (study intervention) versus those who did not. Discharges from intensive care, oncology, and transplant services were excluded. Patient-encounter data and pharmacist study intervention were analyzed, with 30-day hospital readmission odds as the primary endpoint. Pharmacist documented clinical interventions conducted during the study intervention were also analyzed for secondary outcomes of patient and cost saving outcomes. Generalized estimating equations accounted for repeated encounters and assessed the influence of discharge medication reconciliation on 30-day hospital readmission odds, including interaction with case mix index.</p><p><strong>Results: </strong>Of 14 592 discharges, 12 367 (84.8%) met the inclusion criteria, and 8469 (68.0%) received pharmacist-led discharge medication reconciliation, which is the study intervention. In the fourth quarter, 3170 discharges were evaluated. Among patients who did not receive pharmacist-led discharge medication reconciliation (n = 871), a not receiving PL-DMR was associated with significantly greater 30-day hospital readmission odds (OR, 1.06; 95% CI 1.00-1.11; <i>P</i> = .036). Patients discharged from the Digestive Diseases Institute without pharmacist-led discharge medication reconciliation had higher odds of readmission (OR, 2.14; 95% CI 1.14-3.99; <i>P</i> = .017), although this association was not significant after accounting for interaction with case mix index in the intervention model (OR, 1.47; 95% CI 0.52-4.19; <i>P</i> = .467). Surgical patients who did not receive pharmacist-led discharge medication reconciliation also showed a non-significant increase in 30-day hospital readmission odds (OR, 2.73; 95% CI 0.90-8.29; <i>P</i> = 0.076). In 2024, 437 pharmacist documented clinical interventions during the process of discharge medication reconciliation contributed an estimated $240 448.77 in cost avoidance.</p><p><strong>Conclusion: </strong>Pharmacist-led discharge medication reconciliation mitigated complexity-related readmissions, resulting in cost savings. These findings support implementation of transitions-of-care services.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787261470576"},"PeriodicalIF":0.9,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmaceutical 3D Printing From Personalized Medicine to Super-Compounding Pharmacies: A Narrative Review.","authors":"Michele Favia, Giulio De Vivo, Paola Cristina Cappelletto, Gabriele Bagaglini","doi":"10.1177/00185787261478466","DOIUrl":"10.1177/00185787261478466","url":null,"abstract":"<p><strong>Objectives: </strong>This narrative review explores how pharmaceutical 3-dimensional printing (3DP) can transform solid dosage form manufacturing from industrial mass production to truly personalized medicine, particularly for vulnerable cohorts such as pediatric, geriatric, and rare disease patients for whom conventional strengths and dosage forms are often inadequate and prompt unsafe manipulations like tablet splitting. It further aims to critically appraise the main 3DP technologies applicable in pharmacy - fused deposition modeling combined with hot melt extrusion, semi-solid extrusion, direct powder extrusion, selective laser sintering, and photopolymerization - in terms of active pharmaceutical ingredient stability, process and hardware complexity, and clinical scalability, within contemporary regulatory frameworks.</p><p><strong>Methods: </strong>A structured literature search of PubMed/MEDLINE up to April 2026, complemented by an analysis of European Medicines Agency (EMA) guidance documents, was performed to identify narrative and systematic reviews and case reports dealing with extemporaneous 3D-printed solid dosage forms in pharmacy settings, applying predefined inclusion criteria on study design, topic, publication date, and language.</p><p><strong>Results: </strong>The evidence converges on 5 key 3DP platforms currently suitable for pharmaceutical use, each enabling different strategies for dose titration, internal geometry design, and release modulation, while also presenting specific challenges related to thermal stress, material selection, and equipment requirements. Across these technologies, 3DP supports precise dosing, mini-tablet configurations, and personalized polypills that can enhance adherence and allow tailored pharmacokinetic profiles, and emerging hospital-based applications demonstrate the feasibility of point-of-care production supported by in-line, non-destructive quality control using process analytical technology tools such as NIR and Raman spectroscopy.</p><p><strong>Conclusion: </strong>Pharmaceutical 3D printing requires significant investment in infrastructure and navigating distinct regulatory paths, with the U.S. relying on 503A compounding guidelines while the EMA mandates strict EU GMP Annex 11 compliance for non-standard processes. The integration of non-destructive PAT tools, such as NIR and Raman spectroscopy, together with automated and validated digital systems, is essential for establishing an auditable framework for personalized, on-demand, hospital-based drug manufacturing.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787261478466"},"PeriodicalIF":0.9,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extensive Subcutaneous Hematoma in a Patient Receiving <i>Nigella sativa</i> Oil, Dual Antiplatelet Therapy, and Oxaliplatin-Based Chemotherapy: A Case Report.","authors":"Amirhosein Arab, Sima Ramezaninejad, Ebrahim Salehifar","doi":"10.1177/00185787261482136","DOIUrl":"10.1177/00185787261482136","url":null,"abstract":"<p><strong>Background: </strong><i>Nigella sativa</i> (black seed) oil is a commonly used herbal supplement. Here, we report the case of a patient enrolled in a clinical trial of <i>N. sativa</i> oil for chemotherapy-induced peripheral neuropathy (CIPN), who developed a large subcutaneous hematoma while receiving oxaliplatin-based chemotherapy in combination with dual antiplatelet therapy.</p><p><strong>Case presentation: </strong>A 51-year-old man with colon cancer receiving FOLFOX plus cetuximab and dual antiplatelet therapy developed a large subcutaneous hematoma while participating in a clinical trial evaluating <i>N. sativa</i> oil for CIPN. After dose escalation to 2000 mg/day, progressive swelling and marked ecchymosis developed. Laboratory testing revealed clinically significant thrombocytopenia (platelet count: 52 × 10³/µL). All suspected hemostasis-modifying agents were interrupted, and supportive management was initiated, resulting in complete resolution of the hematoma within 10 days. The patient was later re-exposed to a reduced dose (1000 mg/day) without recurrence of bleeding. The Naranjo Adverse Drug Reaction Probability Scale yielded a score of 4, indicating a possible adverse drug reaction.</p><p><strong>Conclusions: </strong>This case suggests a possible hemorrhagic complication in a patient with multiple concurrent bleeding risk factors, including dual antiplatelet therapy and chemotherapy-associated thrombocytopenia, in the setting of <i>N. sativa</i> oil exposure. It highlights the importance of systematically documenting herbal supplement use and proactively counseling patients about potential herb-drug interactions during cytotoxic chemotherapy.</p><p><strong>Trial registration: </strong>Iranian Registry of Clinical Trials (IRCT), https://www.irct.ir, IRCT20090613002027N24.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787261482136"},"PeriodicalIF":0.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dose and Time Dependent Elevations of Initial Unfractionated Heparin Anti-Xa Levels Associated With Low Molecular Weight Heparin Administration.","authors":"Ananth Anthes, Sarah Providence, Xinhua Zhao","doi":"10.1177/00185787261478471","DOIUrl":"10.1177/00185787261478471","url":null,"abstract":"<p><strong>Background: </strong>Intravenous unfractionated heparin (UFH) is routinely utilized for anticoagulation in acute care patients. Appropriate laboratory monitoring is an essential component of UFH therapy, including minimizing the effect of variables that interfere with the monitoring assays. While alterations in anti-factor Xa (anti-Xa) values due to factor Xa inhibitors have been described, the dose-dependent influence of low molecular weight heparins (LMWHs) has not been widely reported.</p><p><strong>Objective: </strong>The purpose of this study was to evaluate the impact of LMWH on initial UFH anti-Xa values in patients with recent LMWH exposure.</p><p><strong>Methods: </strong>This was a retrospective cohort study using national Veterans Affairs data from 2014 to 2025 with UFH anti-Xa monitoring to assess the proportion of elevated anti-Xa levels (>0.7 IU/mL) among 3 groups, defined as recipients of treatment-dose LMWH, no LMWH, and prophylactic-dose LMWH within 24 hours prior to initiation of UFH therapy.</p><p><strong>Results: </strong>The proportion of initial elevated anti-Xa values with treatment-dose LMWH 24 hours prior to UFH was significantly greater at 48.3% compared to no LMWH (18.0%) or prophylactic-dose LMWH (24.0%; <i>P</i> = .0002), with the treatment-dose median (interquartile range [IQR]) anti-Xa significantly elevated at 1.21 (0.69-1.71) compared to no LMWH (0.43 [0.21-0.83]) or prophylactic-dose LMWH (0.48 [0.28-0.83]; <i>P</i> < .0001). The proportion of initial elevated anti-Xa levels with treatment-dose LMWH 48 hours prior to UFH was significantly greater at 37.0% compared to no LMWH (17.8%) or prophylactic-dose LMWH (25.8%; <i>P</i> = .002), with the treatment-dose median (IQR) anti-Xa significantly elevated at 0.96 (0.36-1.82) compared to no LMWH (0.42 [0.21-0.83]) or prophylactic-dose LMWH (0.49 [0.28-0.84]; <i>P</i> = .0002). The median duration of elevated anti-Xa levels was significantly longer with treatment-dose LMWH administered within both 24 and 48 hours prior to UFH (14.0 and 13.6 hours, respectively) compared to no LMWH (8.3 hours) or prophylactic-dose LMWH (7.5 and 7.6 hours; <i>P</i> = .02 and <i>P</i> = .03, respectively).</p><p><strong>Conclusion and relevance: </strong>When LMWHs are administered prior to UFH, there is a dose- and time-dependent association with a significantly increased risk of initial elevated UFH anti-Xa levels, as well as an extended duration of these elevated values. Institutions should assess the impact of LMWH therapies on anti-Xa monitoring to guide local anticoagulation practices.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787261478471"},"PeriodicalIF":0.9,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13526177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}