International Journal of Clinical Pharmacy最新文献

{"title":"Safety evaluation of afatinib in patients with a history of interstitial lung disease using data from an administrative claims database in Japan.","authors":"Ryo Inose, Kuniyoshi Hayashi, Toshiyuki Sakaeda","doi":"10.1007/s11096-026-02114-2","DOIUrl":"10.1007/s11096-026-02114-2","url":null,"abstract":"<p><strong>Introduction: </strong>Afatinib, an epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), is an effective treatment agent for lung cancer with uncommon epidermal growth factor receptor (EGFR) mutations. EGFR-TKIs should be administered with caution in patients with a history of interstitial lung disease (ILD); however, such patients are often excluded from clinical trials, and evidence on afatinib safety in this population remains limited.</p><p><strong>Aim: </strong>To exploratorily evaluate the safety profile of afatinib in patients with a history of ILD using an administrative claims database and investigate whether severe ILD events occur uniformly across patient backgrounds or cluster within specific patient profiles.</p><p><strong>Method: </strong>We analyzed data of patients who received afatinib between May 1, 2014 and November 30, 2020 from the administrative claims database provided by Medical Data Vision Co., Ltd. Severe ILD was defined using two claims-based operational definitions: (1) a broader primary definition combining ILD diagnostic codes and high-dose intravenous corticosteroid administration; (2) a stricter definition requiring intravenous methylprednisolone for sensitivity analysis. Classification and Regression Trees (CART) were used to exploratorily identify patient profiles associated with severe ILD.</p><p><strong>Results: </strong>Among 2,174 patients treated with afatinib, 12.3% (267/2,174) had a history of ILD. Using the primary definition, severe ILD occurred in 6.0% (16/267) of these patients, whereas 3.4% (9/267) met the stricter definition. Although CART analyses yielded different split variables and cutoff values across the two definitions, both consistently indicated that severe ILD events were concentrated within specific patient profiles rather than being uniformly distributed across the population.</p><p><strong>Conclusion: </strong>In patients with a history of ILD, the incidence of severe ILD following afatinib treatment was clarified. CART-derived findings should be interpreted as exploratory signals suggesting clustering of severe ILD events within particular patient profiles. However, as severe ILD was identified using claims-based operational definitions, outcome misclassification cannot be excluded despite sensitivity analyses. Further studies are warranted to validate these findings in independent real-world datasets with richer clinical detail and to support more precise stratification of severe ILD occurrence.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1381-1389"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147473610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eosinophilia-related adverse events reporting associated with medications: a disproportionality and regression analysis of the FDA Adverse Event Reporting System.","authors":"Haimo Liu, Xingang Li, Yiqi Sun, Siyang Song, Sheng Cheng, Yin Liao, Weina Wang, Fang Yi","doi":"10.1007/s11096-026-02109-z","DOIUrl":"10.1007/s11096-026-02109-z","url":null,"abstract":"<p><strong>Introduction: </strong>Eosinophilia encompasses a wide spectrum of hematologic and non-hematologic disorders, and may lead to clinically significant organ damage. Although numerous medications have been implicated in eosinophilia and related hypersensitivity reactions, their overall drug-associated risk remains unclear. Real-world pharmacovigilance data can provide important insights into rare but serious eosinophilia-related adverse events (AEs). This study investigated the demographic and drug-related risk factors for eosinophilia-associated AEs using a large dataset from the US Food and Drug Administration Adverse Event Reporting System (FAERS).</p><p><strong>Aim: </strong>To comprehensively evaluate the associations between a broad range of medications and eosinophilia-related AEs.</p><p><strong>Method: </strong>FAERS reports from 2004 Q1 to 2025 Q1 were analyzed. Four disproportionality algorithms-reporting odds ratio, proportional reporting ratio, Multi-item Gamma Poisson Shrinker, and Bayesian Confidence Propagation Neural Network-were applied to identify drugs with significant safety signals. LASSO regression was used for variable selection, followed by a multivariate logistic regression analysis. The Bonferroni correction was applied for multiple comparisons. The time to onset of eosinophilia-related AEs was evaluated.</p><p><strong>Results: </strong>In total, 55,456 eosinophilia-related AEs were identified. Using all four disproportionality methods, 173 drugs were significantly associated with eosinophilia. These included anti-infective medications (82/173), cardiovascular agents (20/173), nervous system drugs (16/173), antineoplastic and immunomodulatory therapies (14/173), digestive system drugs (9/173), respiratory system drugs (9/173) and other medications (23/173). LASSO followed by multivariate logistic regression identified 60 drugs that were independently associated with higher reporting odds within the FAERS database along with several demographic characteristics. Male sex and age 56-69 years were also significantly associated with higher reporting odds (adjusted p < 0.01). Among reports with available timelines, the median time to onset of eosinophilia-related AEs was 20 days (interquartile range 7-44 days).</p><p><strong>Conclusion: </strong>This large pharmacovigilance study identified the key demographic and drug-related risk factors for eosinophilia-associated AEs. These findings highlight the need for increased clinical vigilance, especially during the early weeks of therapy and among patients with identified risk factors. Although causality cannot be established from the FAERS data, the results offer valuable real-world evidence to support the early detection, risk mitigation, and post-marketing safety monitoring of medications associated with eosinophilia.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1326-1338"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147511864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cross-sectional evaluation of community pharmacists' opinions on caring for visually impaired patients: pharmacist experiences, confidence and recommendations for improved care.","authors":"Aoife Goodwin-Boers, Harriet Bennett-Lenane","doi":"10.1007/s11096-026-02120-4","DOIUrl":"10.1007/s11096-026-02120-4","url":null,"abstract":"<p><strong>Introduction: </strong>Health inequalities and medication management challenges are apparent for people with disabilities, including those who are visually impaired (VI). Community pharmacists are well placed to provide advice and support to VI patients. It is imperative for appropriate care that they are adequately prepared to adapt practice for these patients.</p><p><strong>Aim: </strong>The study aimed to elucidate current experiences, perceived confidence and priorities of community pharmacists when caring for VI patients. It also aimed to understand current barriers and recommendations for practice adaptations to improve care of this cohort.</p><p><strong>Method: </strong>This study utilised an online cross-sectional questionnaire comprising multiple choice, Likert scale and open text questions. This questionnaire was disseminated to registered community pharmacists in Ireland. Responses were coded and analysed quantitatively using descriptive and inferential statistics-whereby p < 0.05 denotes statistical significance. Open-text responses were analysed using conventional content analysis.</p><p><strong>Results: </strong>Data were collected from 235 pharmacists (5.4% response rate). Approximately 70% (69.8%, n = 164) had previous experience providing care to VI patients, while over 90% (91.9%, n = 214) believed that VI patients are at increased risk of medication related harm. Pharmacists with over 10 years' experience (75.4% n = 98) were significantly more likely to feel confident caring for VI patients than those less experienced (52.9%, n = 18), p < 0.05. Only 10.3% (n = 24) believed the pharmacy teams they work with were adequately trained to care for VI patients, while 69.0% (n = 162) do not believe they have been provided with sufficient training and guidance on this topic. Most pharmacists would welcome training to identify (90.6%, n = 213) and guide management of VI patients (92.3%, n = 216). Open text responses revealed recommendations of adaptions to care. Respondent recommendations related to pharmacy physical layouts, patient identification, tailored medication dispensing practices, use of technology and improved communication methods.</p><p><strong>Conclusion: </strong>This study revealed valuable insights into Irish community pharmacists' experiences, confidence and recommendations for adapting care for VI patients. Current barriers in addition to confidence and knowledge deficits and a lack of relevant training amongst pharmacists were identified. Further emphasis on this topic in undergraduate pharmacy programmes and continuing professional development training can help community pharmacists provide equitable care to VI patients.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1424-1432"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147480579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ABCC2 rs2273697 is an independent determinant of tacrolimus intra-patient variability during the first year after kidney transplantation.","authors":"Jia You, Hongxia Liu, Yunyun Yang, JiaZhao Fu, Mingxing Sui, Wenyu Zhao, Zhilong Yuan, Tao Ma, Zhuo Wang, Xuebin Wang","doi":"10.1007/s11096-026-02117-z","DOIUrl":"10.1007/s11096-026-02117-z","url":null,"abstract":"<p><strong>Introduction: </strong>Tacrolimus is a critical immunosuppressive agent in kidney transplantation, but its pharmacokinetic variability, especially intra-patient variability (IPV), can lead to suboptimal outcomes. Genetic polymorphisms in CYP3A5 and ABCC2 may influence tacrolimus metabolism and transport, affecting dosing requirements and IPV. However, their combined impact during the first year after kidney transplantation remains insufficiently characterized.</p><p><strong>Aim: </strong>This study aimed to evaluate the influence of CYP3A5*3 (rs776746) and ABCC2 (rs3740066, rs2273697) polymorphisms on tacrolimus exposure, IPV (C0-IPV and C0/D-IPV), and short-term renal allograft function in kidney transplant recipients, with a focus on the first post-transplant year.</p><p><strong>Method: </strong>A prospective cohort of 60 kidney transplant recipients was followed for one year. Tacrolimus trough concentrations (C0) were measured on postoperative Day 7, Day 14, Month 1, Month 3, Month 6, and Year 1. IPV was assessed using C0-IPV and dose-adjusted C0/D-IPV. Genotyping was performed using the SNaPshot platform. Multivariable regression models identified predictors of IPV and renal allograft function was evaluated by estimated glomerular filtration rate (eGFR) at Year 1.</p><p><strong>Results: </strong>CYP3A5*3 expressers required significantly higher tacrolimus doses than non-expressers from Day 7 through Month 3 (P < 0.05) and showed correspondingly lower C0/D values during this period (P < 0.01). ABCC2 rs3740066 was associated with C0/D at Month 6 (P = 0.037) and with the daily dose at Year 1 (P = 0.045). In the multivariable analysis, the ABCC2 rs2273697 variant (β = 8.429, 95% CI: 1.301-15.557, P = 0.021) was independently associated with tacrolimus C0-IPV. No significant associations were observed between IPV (C0-IPV or C0/D-IPV) and eGFR at Year 1.</p><p><strong>Conclusion: </strong>CYP3A5 genotyping remains valuable for optimizing initial tacrolimus dosing, while ABCC2 polymorphisms, particularly rs2273697, contribute to tacrolimus C0-IPV during the first post-transplant year. Personalized dosing strategies using pharmacogenetic data could improve tacrolimus exposure stability. Larger studies with extended follow-up are needed to assess the long-term clinical implications of these findings.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1390-1400"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147480664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a LASSO-logistic regression model for predicting subtherapeutic infliximab trough concentrations in patients with Crohn's disease.","authors":"Jialin Song, Xiaoyan Li, Wenjiao Wu, Xiang Peng, Jingwen Xie, Xuelian He, Yiting Wang","doi":"10.1007/s11096-026-02106-2","DOIUrl":"10.1007/s11096-026-02106-2","url":null,"abstract":"<p><strong>Background: </strong>Infliximab (IFX), a monoclonal antibody that neutralizes tumor necrosis factor-α, is widely used as a biologic treatment for Crohn's disease (CD). Despite its established efficacy, a substantial proportion of patients develop subtherapeutic IFX trough concentrations (< 3 μg/mL), leading to diminished clinical response and treatment failure. Early identification of high-risk individuals remains challenging due to the multifactorial nature of IFX pharmacokinetics.</p><p><strong>Aim: </strong>This study integrated Least Absolute Shrinkage and Selection Operator (LASSO)-based variable selection with multivariable logistic regression to identify CD patients at risk for subtherapeutic IFX trough levels during induction.</p><p><strong>Method: </strong>A total of 347 patients diagnosed with CD who commenced IFX induction therapy at the Sixth Affiliated Hospital of Sun Yat-sen University from January to December 2023 were retrospectively reviewed in this study. Comprehensive demographic, clinical, and biochemical data were retrieved from electronic records. Variable selection was performed using the Least Absolute Shrinkage and Selection Operator (LASSO), after which a multivariable logistic model was developed. Model discrimination, calibration and clinical usefulness were assessed through the area under the receiver operating characteristic curve (AUC), calibration curves, decision curve analysis (DCA) and clinical impact curves (CIC).</p><p><strong>Results: </strong>Of the 347 participants, 148 (42.7%) exhibited subtherapeutic IFX trough concentrations. LASSO and multivariable logistic analyses identified four independent predictors: older age at diagnosis (> 40 years), elevated anti-drug antibody levels, higher erythrocyte sedimentation rate and reduced albumin (P < 0.05). The model demonstrated an AUC of 0.737 (95% CI 0.684-0.790), with a bootstrap-adjusted AUC of 0.726 (95% CI 0.697-0.739) based on 1000 resamples. Calibration demonstrated close alignment with observed outcomes, validated by a non-significant Hosmer-Lemeshow test (χ² = 8.447, P = 0.391). DCA and CIC analyses indicated meaningful clinical utility.</p><p><strong>Conclusion: </strong>The proposed LASSO-logistic regression model demonstrates promising predictive performance for identifying subtherapeutic IFX exposure in CD patients. By leveraging readily available clinical data, it enables early risk stratification and individualized therapeutic decision-making, thereby facilitating more effective treatment optimization.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1315-1325"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147283556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug-induced fever: a pharmacovigilance analysis based on the FDA adverse event reporting system.","authors":"Xiaozhi Li, Weichun Zhang, Xiaofen Wen, Danxia Lin, Xiajiong Luo","doi":"10.1007/s11096-026-02113-3","DOIUrl":"10.1007/s11096-026-02113-3","url":null,"abstract":"<p><strong>Introduction: </strong>Drug-induced fever is a common but often under-recognized adverse reaction that can complicate clinical management.</p><p><strong>Aim: </strong>This study aimed to systematically evaluate the risk of drug-induced fever using real-world pharmacovigilance data and to characterize its temporal onset patterns and clinical features.</p><p><strong>Method: </strong>A pharmacovigilance study was conducted utilizing data from the FAERS, covering reports from the first quarter of 2004 to the fourth quarter of 2024. The detection of adverse drug event signals was conducted using disproportionality analysis. The robustness of identified fever signals was assessed through sensitivity analysis. Furthermore, a time-to-onset analysis was undertaken to elucidate factors associated with the development of drug-induced fever.</p><p><strong>Results: </strong>Disproportionality analysis revealed that antineoplastic and immunomodulating agents were the most frequently associated, followed by antiinfectives for systemic use, alimentary tract and metabolism, musculo-skeletal system, nervous system, blood and blood forming organs, dermatologicals, genito urinary system and sexhormones. The top-five drugs with drug-induced fever signals by case number were rituximab (3650 cases), immunoglobulin human normal (2478 cases), zoledronic acid (2304 cases), lamotrigine (1843 cases), dabrafenib (1803 cases). Sensitivity analysis confirmed that the majority of the positive signals remained robust. Analysis of the time-to-onset revealed that drug-induced fever occurred predominantly during the early phase of treatment. Furthermore, female patients experienced an earlier onset compared to males.</p><p><strong>Conclusion: </strong>This large-scale pharmacovigilance analysis identified drugs and patient characteristics associated with drug-induced fever and revealed early-onset patterns, providing evidence to support its early recognition and monitoring in clinical practice.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1370-1380"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147591797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Embedding onsite pharmacists in nursing home practice: qualitative findings from a pilot study.","authors":"Amber Damiaens, Astrid Frisson, Veerle Foulon","doi":"10.1007/s11096-026-02123-1","DOIUrl":"10.1007/s11096-026-02123-1","url":null,"abstract":"<p><strong>Introduction: </strong>Enhancing the role of pharmacists may help reduce medication errors in nursing homes (NHs). To launch the embedding of onsite pharmacists in Flemish NHs, KU Leuven developed a postgraduate course.</p><p><strong>Aim: </strong>This pilot study aimed to (1) evaluate the course and (2) to explore pharmacists' tasks and activities in NHs.</p><p><strong>Method: </strong>The course consisted of three main components: (1) an e-learning, (2) a NH internship, and (3) round table discussions with fellow pharmacists completing the course. Pharmacists also maintained a portfolio, documenting their tasks and activities. Data were collected during two consecutive course cycles, i.e. in 2022 and 2023. Round table discussions were considered as focus groups and included in the evaluation, as were pharmacists' portfolios. Additionally, focus groups were held with NH staff. All round table discussions and focus groups were audio-taped and transcribed verbatim. All data were analysed using an inductive thematic framework.</p><p><strong>Results: </strong>Nineteen pharmacists and 36 NH staff members participated. Six themes emerged: (1) a promising e-learning with opportunities for improvement, (2) the crucial but challenging NH internship, (3) a variety of tasks performed by onsite pharmacists, 4) round table discussions as sources of inspiration and reassurance, (5) call for structural embedding of pharmacists in NHs, (6) consensus on the need for onsite pharmaceutical expertise.</p><p><strong>Conclusion: </strong>The pilot study highlighted the potential role of onsite pharmacists in NHs, emphasizing resident-level and system-level contributions. It also identified opportunities to optimize the postgraduate course and calls for the structural embedding of pharmacists in NH practice.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1452-1461"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147511776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A consolidated framework for implementation research (CFIR) informed exploration of a primary care intervention to support deprescribing for problematic polypharmacy in older adults living with frailty (DEPPLOY) in England: a qualitative study.","authors":"Liz Breen, Amrit Daffu-O'Reilly, Aliya Darr, Jonathan Benn, Beth Fylan, Jonathan Silcock, George Peat, D K Theo Raynor, Duncan R Petty, Syed Tabish Zaidi, Alison Bravington, Nazreen Butt, David P Alldred","doi":"10.1007/s11096-026-02140-0","DOIUrl":"10.1007/s11096-026-02140-0","url":null,"abstract":"<p><strong>Introduction: </strong>The incorporation of deprescribing into structured medication reviews (SMR) is a patient-centred and cost-effective practice in primary care settings. Pharmacists have a key role in deprescribing among older people to improve quality of life and reduce adverse events, but patients and healthcare professionals may be resistant to reducing their medication, and evidence around how deprescribing happens in practice is currently lacking. This study explores the implementation of a co-designed intervention in a single English General Practice (UK).</p><p><strong>Aim: </strong>To explore key stakeholders' perceptions of a co-designed primary care intervention to involve patients and their families in deprescribing and its broader intervention context, guided by the Consolidated Framework for Implementation Research (CIFR).</p><p><strong>Method: </strong>Qualitative semi-structured interview study with a purposive sample of staff, and patients with frailty, to explore perceptions of the deprescribing initiative. Data were analysed using an a priori framework structured by the domains of the CIFR.</p><p><strong>Results: </strong>Interviews (24 in total) were conducted with 13 staff involved in delivering the intervention and 5 patients living with frailty who completed a structured medication review with recommended medication changes. Key factors (mapped to CFIR domains) included: an imperative for formal training around the intervention delivery (Inner setting), engagement with SMR delivery linked to payment through national agendas (Outer setting); the importance of the fit of the intervention with existing processes around prescribing practice and infrastructure (Inner setting); increased understanding of the aims of deprescribing among patients and recognition of the extended pharmacist role in primary care deprescribing (Individuals); recognition that the successful delivery of the intervention was a team effort (Implementation process).</p><p><strong>Conclusion: </strong>Structured medication reviews are a suitable mechanism to discuss and make deprescribing decisions as part of a shared consultation. Resources which support the patient through the deprescribing process can engage patients and promote greater satisfaction with service delivery. Operationally, staff can also benefit from tools which facilitate greater understanding of the process and fit within their usual practice plus improving patient care and saving medication costs. Barriers and facilitators to implementation success should be noted and addressed for upscaling and process sustainability.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1594-1606"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning, adopting, and sustaining the pharmacist-clinician role in clinical practice: a qualitative study among early adopters in the Netherlands.","authors":"Kim-Lara Klerk-Bos, Marije P Hennus, Marco Ehlert, Manon Kluijtmans, Toine C G Egberts, Ingeborg Wilting","doi":"10.1007/s11096-026-02150-y","DOIUrl":"10.1007/s11096-026-02150-y","url":null,"abstract":"<p><strong>Introduction: </strong>Hospital pharmacists are increasingly involved in direct patient care; however, little is known about how to learn, adopt, and sustain this pharmacist-clinician role in practice.</p><p><strong>Aim: </strong>This study aimed to examine the implementation of the pharmacist-clinician role by exploring the key factors that shape its learning, adoption, and sustainment in clinical practice.</p><p><strong>Method: </strong>Early adopters of the pharmacist-clinician role in Dutch hospitals were recruited through purposive sampling via professional networks and national outreach. A semi-structured interview was conducted with the respondents. Data were analysed inductively using thematic analysis and were subsequently interpreted using the Normalisation Process Theory (NPT) to investigate key factors in learning, adopting, and sustaining the pharmacist-clinician role.</p><p><strong>Results: </strong>A total of 21 Dutch pharmacists working in a hospital were included. Factors, grouped into four themes (Scope and role enactment of the pharmacist-clinician role, interprofessional collaboration as the driver for adoption, experiential workplace learning is more important than formal learning, and organisational conditions shape sustainment and scalability) described how the pharmacist-clinician role develops from local sense-making and interprofessional adoption to enactment through workplace learning. Although individual initiative enabled early uptake, the role remained highly context-dependent. An NPT-informed synthesis showed that long-term sustainment relied mainly on organisational support and structural embedding, and less on individual factors.</p><p><strong>Conclusion: </strong>Our findings imply that embedding the pharmacist-clinician role should be approached as an organisational effort rather than merely as an expansion of professional competencies. Its sustainable development requires deliberate implementation, clear role definition, and organisational support for embedding the role in everyday practice.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1672-1681"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inappropriate antibiotic prescribing in Ethiopian hospitals: a systematic review.","authors":"Abdella Birhan Yabeyu, Sarah Wise, Andrew Hayen, Jane Ellen Carland","doi":"10.1007/s11096-026-02157-5","DOIUrl":"10.1007/s11096-026-02157-5","url":null,"abstract":"<p><strong>Introduction: </strong>Inappropriate antibiotic prescribing is a major driver of antimicrobial resistance globally, and its consequences are more severe in low- and middle-income countries such as Ethiopia. Although antibiotics are commonly prescribed for inpatients in Ethiopian hospitals, evidence on their appropriateness remains limited and inconsistent.</p><p><strong>Aim: </strong>This systematic review aimed to assess the prevalence, prescribing characteristics, and factors associated with inappropriate antibiotic prescribing in Ethiopian hospitals.</p><p><strong>Method: </strong>We searched MEDLINE, Embase, Scopus, Web of Science from inception to 4 May 2025, and also searched Google Scholar and manually reviewed the reference lists of eligible studies. Primary studies conducted in Ethiopian hospitals that reported on the appropriateness of inpatient antibiotic prescribing were included. Two authors independently screened studies and extracted data. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools. Because of the heterogeneity in study population, definitions and outcome measures, findings were synthesised descriptively. The review was registered in PROSPERO (CRD420251051881).</p><p><strong>Results: </strong>Fifty-three studies were included from seven Ethiopian regions, most from Amhara (n = 16). Overall, study quality was variable, with common limitations including unclear sampling and incomplete methodological reporting. Most studies focused on adult patients (n = 24) and used the Ethiopian Standard Treatment Guideline (n = 32). Cephalosporins were most frequently assessed (n = 45), ceftriaxone the most commonly evaluated antibiotic (n = 44). Prophylactic and empiric prescribing were commonly reported (n = 29 and n = 28) respectively. The prevalence of inappropriate prescribing reported per patient was a median of 56.8% (range, 10.2% to 91.4%) in 43 studies, and per prescription was a median of 40.7% (range, 19.2% to 66.9%) in nine studies. Indication, dose, dosing frequency, and duration were the prescribing characteristics most frequently reported. Patient-related factors, including comorbidity and polypharmacy were frequently associated with inappropriate prescribing.</p><p><strong>Conclusion: </strong>Inappropriate antibiotic prescribing was common in Ethiopian hospitals, although prevalence varied widely. Inconsistencies in guideline use and prescribing criteria likely contribute to this variability. Frequent empiric and prophylactic prescribing and reliance on ceftriaxone may reflect limited diagnostic capacity and raise concerns about antimicrobial resistance. Strengthening antimicrobial stewardship through standardised prescribing audits and improved diagnostic services is urgently needed to support appropriate antibiotic use in Ethiopia.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1228-1245"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}