International Journal of Clinical Pharmacy最新文献

{"title":"Active surveillance and risk prediction of piperacillin/tazobactam‑associated hypokalaemia: development and external validation of a clinical nomogram.","authors":"Hehe Bai, Miao Guo, Nanbo Zheng, Xiaojing Nie","doi":"10.1007/s11096-026-02195-z","DOIUrl":"10.1007/s11096-026-02195-z","url":null,"abstract":"<p><strong>Introduction: </strong>Piperacillin/tazobactam (TZP) is widely used in hospitalised adults. Real‑world data suggest a higher risk of hypokalaemia than previously recognised.</p><p><strong>Aim: </strong>To investigate incidence, severity and risk factors of TZP‑induced hypokalaemia, and to develop and externally validate a nomogram for individualised risk prediction.</p><p><strong>Method: </strong>This retrospective study included hospitalised adults receiving TZP (2021-2025). TZP‑induced hypokalaemia was defined as serum potassium < 3.5 mmol/L ≥ 48 h after TZP initiation. Logistic regression identified predictors. A nomogram was constructed. Model performance was assessed by discrimination (area under the ROC curve, AUC), calibration (Hosmer‑Lemeshow test, calibration intercept/slope), Brier score and decision‑curve analysis (DCA), with internal and external validation.</p><p><strong>Results: </strong>Among 643 patients, 122 (19.0%) developed TZP‑induced hypokalaemia (mild: 78.7%; moderate: 16.4%; severe: 4.9%). Median time to onset was 5.0 days. Independent predictors were age ≥ 65 years (OR = 2.118, 95% CI 1.003-4.472, p = 0.049), body mass index (OR = 0.671, 95% CI 0.591-0.762, p < 0.001), intensive care unit admission (OR = 2.915, 95% CI 1.504-5.651, p = 0.002), daily dose (OR = 1.280, 95% CI 1.110-1.476, p < 0.001), and baseline serum potassium (OR = 0.123, 95% CI 0.056-0.271, p < 0.001). The nomogram showed good discrimination (training AUC 0.881, internal 0.876, external 0.813), calibration (Hosmer‑Lemeshow p > 0.05), Brier scores < 0.25 and positive net benefit on DCA.</p><p><strong>Conclusion: </strong>TZP‑induced hypokalaemia is common in hospitalised adults. A nomogram based on five readily available clinical variables may facilitate early identification of high‑risk patients, although prospective validation in diverse settings is required before clinical implementation.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"2105-2116"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148578492","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":"Collaborative pharmacist prescribing in community heart failure clinics: a pre-post intervention comparison.","authors":"Matthew Percival, Laetitia Hattingh, Rohan Jayasinghe, James Millhouse, Joanne Crook, Carl De Wet, Ian Hughes, Christopher Freeman","doi":"10.1007/s11096-026-02186-0","DOIUrl":"10.1007/s11096-026-02186-0","url":null,"abstract":"<p><strong>Introduction: </strong>Guideline-directed medical therapy (GDMT) improves outcomes in heart failure, yet many patients remain undertreated or are not titrated to optimal doses. International evidence shows pharmacist-led heart failure clinics improve GDMT prescribing and reduce hospitalisations, but data in Australian settings are limited.</p><p><strong>Aim: </strong>To evaluate whether incorporating a collaborative pharmacist medication prescribing model within a heart failure service improved optimisation of guideline-directed medical therapy (GDMT) in patients with heart failure and ejection fraction < 50% compared with pre-implementation usual care, and to evaluate impacts on service efficiency, hospitalisation, mortality, medication beliefs, and health-related quality of life.</p><p><strong>Method: </strong>An interrupted time series analysis compared 12-month pre- and post-implementation periods following establishment of a collaborative pharmacist medication prescribing clinic across two community heart failure services. Primary outcomes were the proportion of patients optimised on GDMT at 90 days and at clinic discharge. Secondary outcomes included time between visits, monthly attendance, unscheduled hospitalisations, medication adherence and health related quality of life (HRQoL) assessed with the EuroQoL five-dimension five-level health status instrument visual analogue scale (EQ-VAS) and the Kansas City Cardiomyopathy Questionnaire (KCCQ-12).</p><p><strong>Results: </strong>A total of 302 patients with ejection fraction < 50% were included, with 98 and 204 patients in the pre- and post-implementation cohort respectively. Overall, 285 patients (94.4%) had a left ventricular ejection fraction ≤ 40%, with similar proportions between cohorts (94.6% vs. 93.9%; p = 1.000). Optimisation of GDMT increased from 19.3% (n = 19) to 40.2% (n = 82) at 90 days (adjusted OR = 2.6, p = 0.001), and from 43.9% (n = 43) to 88.2% (n = 180) at discharge (adjusted OR = 13.2, p < 0.001). Median time between visits decreased from 49 to 28 days (p < 0.001), while mean monthly attendance increased from 9 to 16 (p < 0.001). HRQoL scores increased within the post-implementation group, measured by the KCCQ-12 (74.0 → 84.8, p < 0.001) and EQ-VAS (73.0 → 79.5, p = 0.004). Medication adherence remained high according to self-reported Medication Adherence Report Scale (MARS) scores. No change in hospitalisations or mortality was observed.</p><p><strong>Conclusion: </strong>Introducing a collaborative pharmacist medication prescribing clinic to usual care was associated with higher rates of GDMT optimisation and increased clinic throughput. These findings support the feasibility of collaborative prescribing models to facilitate GDMT optimisation within Australian health services.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"2050-2063"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470369","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 multi-method study of unlicensed medicine risk assessment: a cross-sectional survey of pharmacy procurement leads and policy analysis across NHS trusts in England.","authors":"Grant Sugiura, Sam Gregory, Francesca Greco, Daniel Grant, Nilesh Patel","doi":"10.1007/s11096-026-02164-6","DOIUrl":"10.1007/s11096-026-02164-6","url":null,"abstract":"<p><strong>Introduction: </strong>Medicines which lack a marketing authorisation, referred to as unlicensed medicines, are used across healthcare systems internationally. Their use carries recognised quality and safety risks, yet no published evidence describes how healthcare institutions assess and mitigate these risks at a system level.</p><p><strong>Aim: </strong>This study aimed to explore the processes and variation in risk assessment for unlicensed medicines across NHS trust hospital pharmacies in England.</p><p><strong>Method: </strong>A multi-method design was used. An online questionnaire was distributed to pharmacy procurement leads across NHS trusts in England (n = 37). Concurrently, unlicensed medicines policies from 40 NHS trusts were analysed using a structured coding framework developed through iterative refinement. The questionnaire collected data on unlicensed medicines risk assessment volume, scope, and governance; policies were analysed to identify organisational intended practice. Datasets were independently analysed and compared at code level across eighteen shared elements to examine variations between practice and policy.</p><p><strong>Results: </strong>Approximately three quarters of questionnaire respondents (73%; 27/37) reported completing both quality and clinical risk assessments for all unlicensed medicines procured, and most trusts (92%; 34/37) had an unlicensed medicine policy; however, only 65% (24/37) reported clearly defined governance oversight, and 57% (21/37) cited formal approval of unlicensed medicine use. Practices were heterogeneous: risk assessments frequently focused on product identity (e.g., 86%; 32/37, considered country of manufacture) but rarely examined processes of manufacturing or sterilisation. A minority (16%; 6/40) used a formal risk scoring system, and review cycles were inconsistent, with 41% of policies (16/40) not mandating review periods. Policies typically mandated risk assessment and recording on a register but varied in technical detail and rarely indicated that quality checks were required upon receipt. Comparison of findings revealed probable duplication of effort in risk assessment for commonly procured unlicensed medicines and divergence between policy emphasis and practitioner focus.</p><p><strong>Conclusion: </strong>NHS trusts routinely risk assess unlicensed medicines yet do so independently, with variation in risk assessment content, limited use of structured scoring, and gaps in post-receipt- verification. A national minimum dataset for risk assessment and a shared repository of completed assessments could reduce duplication, improve consistency, and strengthen patient safety.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1915-1925"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148029884","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":"Budget impact analysis of medication reviews by junior pharmacists in polypharmacy patients: a hospital perspective.","authors":"Toon Hectors, Thirza Kooijman, Marit van Barreveld, Marianne Kuijvenhoven, Patty Teeuwisse, Rik Olde Engberink","doi":"10.1007/s11096-026-02190-4","DOIUrl":"10.1007/s11096-026-02190-4","url":null,"abstract":"<p><strong>Introduction: </strong>Pharmacist-led medication reviews are increasingly recognised for generating cost savings within the hospital. However, no cost-analysis has investigated the budget impact of junior pharmacists conducting medication reviews under supervision of clinical pharmacists, nor included recommendations to start-, increase-, or monitor medications.</p><p><strong>Aim: </strong>To assess the budget impact of medication reviews by supervised junior pharmacists across hospital wards, explore budget impact differences between drug classes, and identify patient predictors that potentially influence the budget impact.</p><p><strong>Method: </strong>Data of medication reviews were collected over a 19-month period in patients with polypharmacy (≥ 5 medications) who had at least one additional risk factor. We developed a cost model over a one-year horizon, from the hospital perspective. Intervention costs were derived from measured labour time per medication review and salary of junior- and clinical pharmacists. Cost avoidance from potential preventable medication-related readmissions were based on admission time, admission costs and an estimate of preventable medication-related admissions (4.8%). Costs and savings from medication recommendations were aggregated using drug price per daily defined dose and its predicted days of therapy per year, and clustered by drug class. Scenario analyses tested the robustness of medication recommendation savings to account for effectively implemented and additional monitoring recommendations. Patient predictors of budget impact related to medication recommendations were assessed using multivariable linear regression, including age, gender, eGFR, acute admission, medication count, comorbidity, expensive drugs, and ward type.</p><p><strong>Results: </strong>We collected 271 medication reviews, including 1,689 medication recommendations. Per-patient budget impact was negative for the intervention (€104 costs), but positive for medication recommendations (€46 savings), and preventable medication-related readmissions (€239 savings). Total estimated savings were €181 per patient, and €688,000 when upscaled hospital-wide. Opiates, beta receptor agonists, corticosteroids, urological drugs, and muscarine receptor antagonists generated 43% of medication recommendation savings. Erythropoietic growth factors, SGLT2 inhibitors, etanercept, etravirine, and calcium/vitamin D formulations generated 70% of medication recommendation costs. No significant associations were found between any of the included patient characteristics and budget impact related to medication recommendations.</p><p><strong>Conclusion: </strong>Junior pharmacist-led medication reviews provide a modest cost-saving intervention from the hospital perspective, demonstrating savings across clinical populations with polypharmacy.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"2073-2081"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470371","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":"Beyond symptom change: a qualitative descriptive study of reported quality of life experiences among adults prescribed medicinal cannabis for anxiety disorders.","authors":"Leah Roberts, Craig Cumming, Charley A Budgeon, David B Preen, Kenneth Lee","doi":"10.1007/s11096-026-02176-2","DOIUrl":"10.1007/s11096-026-02176-2","url":null,"abstract":"<p><strong>Introduction: </strong>Anxiety disorders are among the most prevalent and disabling mental health conditions and are associated with impairments in quality of life (QoL). Previous studies have examined medicinal cannabis for anxiety and QoL using short-term follow-up or cross-sectional surveys. However, there is little longitudinal qualitative research examining how patients experience QoL changes.</p><p><strong>Aim: </strong>To explore the perceived impacts on QoL for people with diagnosed anxiety disorders over the first six to twelve months after commencement of medicinal cannabis treatment.</p><p><strong>Method: </strong>A qualitative descriptive study was conducted using semi-structured interviews and participant diary entries. Adults with an anxiety disorder who had initiated medicinal cannabis within the previous six months were purposively recruited from clinics across Australia. Diary entries were completed at three and six months to capture evolving treatment experiences, with semi-structured interviews conducted within 12 months of treatment commencement. Data were analysed inductively using reflexive thematic analysis following Braun and Clarke's methodology.</p><p><strong>Results: </strong>Nine participants (median age 36 years) were included, eight completed diary entries and interviews, and one completed interview only. Participants described improvements across QoL domains following initiation of medicinal cannabis. Themes reflected benefits and challenges, including reclaiming agency over anxiety, QoL changes, social and legal concerns, barriers to treatment initiation, and future treatment intentions. Participants reported perceived improvements in sleep, emotional regulation, relationships, motivation, daily functioning, and overall wellbeing. Several participants also described greater engagement with coping strategies and increased participation in social and daily activities. These benefits occurred alongside challenges, including stigma surrounding disclosure of medicinal cannabis treatment and concerns about cannabis driving legislation and roadside drug testing.</p><p><strong>Conclusion: </strong>Participants perceived medicinal cannabis as a tool for managing anxiety rather than eliminating symptoms, contributing to improved QoL across domains. Findings highlight the importance of considering QoL alongside symptom management and the role of pharmacists and other healthcare professionals in supporting patients through counselling, treatment monitoring, and stigma reduction. There is a need for evidence-informed policy that balances road safety measures while minimising unintended social and legal harms for patients prescribed medicinal cannabis.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1979-1990"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204638","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":"Causes and types of voluntarily reported unintentional medication discrepancies in care transitions: a cross-sectional study.","authors":"Betsie Limmen, Joy van Broekhuizen, Rob Essink, Judith de Ruijter-van Dalem, Linda van Eikenhorst, Patricia M L A van den Bemt, Fatma Karapinar-Çarkit","doi":"10.1007/s11096-026-02189-x","DOIUrl":"10.1007/s11096-026-02189-x","url":null,"abstract":"<p><strong>Introduction: </strong>Medication incident reporting systems enable healthcare professionals to report incidents and their analysis may help prevent reoccurrences. While previous research has primarily focused on medication errors in general, incidents involving unintentional medication discrepancies remain unexplored.</p><p><strong>Aim: </strong>Therefore, this study aimed to identify the causes of voluntarily reported medication incidents describing unintentional medication discrepancies occurring in care transitions. The secondary objective was to characterise the reported medication incidents regarding type of incident, medication involved, whether the incident reached the patient, and the transfer moment involved.</p><p><strong>Method: </strong>This cross-sectional study used data from the National Medication Incident Reporting database of the Dutch Institute for Rational Use of Medicine. This database contains medication incidents, mainly reported by healthcare professionals in hospitals. Incidents were included if they described an unintentional medication discrepancy in a care transition. The primary outcome was the cause of the reported incident independently determined by two researchers using the Prevention and Recovery Information System for Monitoring and Analysis model (PRISMA-Medical). Secondary outcomes were the incident type (e.g., omissions or dose discrepancies), the medication involved, whether the incident reached the patient, and the transfer moment. Descriptive statistics were used for data-analysis (frequencies and percentages).</p><p><strong>Results: </strong>A total of 32,261 incidents were reported in the study period, of which 992 (3.1%) met the inclusion criteria. Most incidents were attributed to human factors (n = 932; 94.0%), with verification errors (n = 492; 49.6%) and intervention errors (n = 246; 24.8%) being the most common. Organisational and technical causes accounted for 40 (4.0%) and 20 (2.0%) incidents, respectively. Omissions represented the most frequent type of discrepancies (n = 354; 36.2% of 978 reported discrepancy types), and cardiovascular medication was most frequently involved (n = 339; 24.9% of 1,360 reported medications). Among incidents with available data (n = 599), 444 (74.1%) reached the patient. Most incidents occurred at hospital admission (n = 679; 71.4% of 951 incidents with data available) and discharge (n = 229; 24.1%).</p><p><strong>Conclusion: </strong>Most reported incidents in care transitions were attributable to human error. These findings highlight the need for better preventive measures, e.g. patient-centred medication reconciliation to enhance patient safety.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"2064-2072"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497271","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":"Validation of an updated French national tool for reporting pharmacist interventions for all healthcare products.","authors":"Rémi Toth, Eléonore Martin, Cordélia Salomez-Ihl, Magali Bourdelin, Julien Boyer, Virginie Chasseigne, Perrine Drancourt, Antoine Dupuis, Caroline Figeac, Aurélie Fresselinat, Stéphanie Genay, Anne-Françoise Germe, Lucie Germon, Julien Gravoulet, Audrey Janoly-Dumenil, Michel Juste, Isabelle Le Du, Morgane Masse, Céline Mongaret, Fabien Nativel, Jérôme Perrey, Chloé Rousseliere, Delphine Schmitt, Pierrick Bedouch, Bertrand Décaudin","doi":"10.1007/s11096-026-02181-5","DOIUrl":"10.1007/s11096-026-02181-5","url":null,"abstract":"<p><strong>Introduction: </strong>In France, two validated tools (collectively referred to as \"Act-IP©\") are commonly used to report pharmacist interventions in both community and hospital pharmacy settings. These tools were designed primarily for drug-related pharmacist interventions and are less suited to those related to medical devices. To address this limitation, the French Clinical Pharmacy Society and the French Medical Device Pharmacy Society are jointly developing a rating tool that encompasses all healthcare products.</p><p><strong>Aim: </strong>To assess inter-rater agreement for \"product-related problem\" and \"pharmacist intervention\" items in a revised version of the Act-IP© during validation by internal and external panels and to evaluate the tool's feasibility and acceptability.</p><p><strong>Method: </strong>The revised Act-IP© was based on two previously validated tools; items were revised or added to encompass interventions involving medical devices and drugs. Six expert hospital pharmacists were recruited for the internal validation, and pharmacists attending a national congress were recruited for the external validation. In both validation processes, 60 scenarios had to be rated using the new tool. Each scenario included a case report, a product-related problem, and the corresponding pharmacist interventions. The Clinical, Economic, and Organizational Scale was also used to rate the impacts of each pharmacist intervention. Inter-rater agreement was evaluated using Fleiss's kappa (κ, interpreted according to Landis and Koch's conventions).</p><p><strong>Results: </strong>The revised Act-IP© included 11 product-related problem items (10 revised and one new) and eight pharmacist intervention items (5 revised and one new). In the internal validation, the mean κ values were 0.63 for product-related problems and 0.77 for pharmacist interventions. In the external validation, the mean κ values were lower: 0.42 for product-related problems and 0.52 for pharmacist interventions; this reflecting time constraints, real-world assessment conditions, and greater variability among raters. The level of inter-rater agreement for the Clinical, Economic, and Organizational Scale was low and - despite the tool's usability and applicability - highlighted variability in the raters' judgements.</p><p><strong>Conclusion: </strong>The present findings validate the revised Act-IP© for reporting pharmacist interventions. Further work is needed to optimize the tool's implementation and develop specific training programs for hospital pharmacists.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"2015-2025"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387567","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 qualitative exploration of healthcare professionals' perspectives on the role of pharmacists in screening older adults for depression during medication reviews.","authors":"Duha N Gide, Sarira El-Den, Lisa Kouladjian O'Donnell, Claire L O'Reilly","doi":"10.1007/s11096-026-02171-7","DOIUrl":"10.1007/s11096-026-02171-7","url":null,"abstract":"<p><strong>Introduction: </strong>Late-life depression (LLD) (depression occurring in individuals aged ≥ 65 years) often goes underdiagnosed and undertreated. Pharmacists who conduct medication reviews may play a significant role in LLD screening.</p><p><strong>Aim: </strong>This study aimed to explore healthcare professionals' (HCPs) perspectives regarding the role of pharmacists in LLD screening for older adults during medication reviews.</p><p><strong>Method: </strong>A semi-structured interview guide was developed, guided by the Theoretical Framework of Acceptability (TFA). HCPs across Australia were recruited via purposive sampling through professional organisations' social media and e-newsletters distributed by primary health networks, and via convenience sampling through departmental meetings and emails at Royal North Shore Hospital, New South Wales, Australia. The interviews explored HCPs' acceptability and perspectives regarding the role of pharmacists in LLD screening. Key themes and subthemes were identified using inductive thematic analysis. Each subtheme was then deductively mapped to the TFA constructs.</p><p><strong>Results: </strong>Twenty-eight HCPs participated in the interviews, including 10 credentialed pharmacists (35.7%), nine hospital pharmacists (32.1%), five geriatricians (17.9%) and four general practitioners (14.3%). Most participants were female (n = 22; 78.6%) and practising in New South Wales, Australia (n = 17; 60.7%). The duration of interviews ranged from 21 to 55 min (M = 33 min, SD = 9 min). Five key themes were identified, including Considerations for service delivery, Patients' homes as screening setting, Resource requirements, Timely follow-up, and Benefits of screening. These themes were further divided into eight subthemes. HCPs generally viewed pharmacist-delivered LLD screening as acceptable, provided certain factors were addressed prior to implementation. Facilitators such as increased patient comfort in their homes and the importance of mental health training were noted; however, barriers such as time constraints, lack of remuneration for additional services and the difficulties of timely follow-up may impede the provision of such services.</p><p><strong>Conclusion: </strong>HCPs were generally accepting of pharmacist-delivered LLD screening during medication reviews, and perceived pharmacists to have a role in such services. Recommendations for future implementation include targeted mental health training for credentialed pharmacists, appropriate remuneration, and timely follow-up pathways for at-risk patients.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1937-1946"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148271323","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 PD-L1 and tumor mutational burden-based predictive model for pathological complete response after neoadjuvant immunotherapy in resectable lung cancer.","authors":"Xiao Wu, Duo Jiang, Bin Li","doi":"10.1007/s11096-026-02191-3","DOIUrl":"10.1007/s11096-026-02191-3","url":null,"abstract":"<p><strong>Introduction: </strong>Neoadjuvant immunotherapy has demonstrated promising efficacy in resectable lung cancer; however, substantial interindividual variability in the treatment response remains. Although programmed death-ligand 1 (PD-L1) expression and tumor mutational burden (TMB) are established biomarkers of immunotherapy response, the performance of predictive models that integrate these biomarkers remains unclear.</p><p><strong>Aim: </strong>To develop and validate predictive models integrating PD-L1 expression and TMB for estimating pathological complete response (pCR) following neoadjuvant immunotherapy in patients with resectable lung cancer and to compare the performance of a nomogram and a random forest model.</p><p><strong>Method: </strong>This retrospective cohort study included 232 patients who underwent surgical resection following neoadjuvant immunotherapy as the model development cohort and were randomly assigned to the training and internal validation sets (7:3). A temporally independent validation cohort of 115 consecutive patients treated at the same institution during a later study period was used to assess the generalizability of the model. Univariate and multivariable logistic regression analyses were performed to identify independent predictors of pCR. A nomogram and random forest model were developed and evaluated in terms of discrimination, calibration, and classification performance.</p><p><strong>Results: </strong>Clinical stage II (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.31-0.94), absence of lymph node metastasis (OR 0.35, 95% CI 0.16-0.77), receipt of immunotherapy combined with chemotherapy (OR 4.00, 95% CI 1.54-10.39), higher PD-L1 expression (OR 1.62, 95% CI 1.03-2.54), and higher TMB (OR 3.07, 95% CI 1.42-6.65) were independently associated with pCR (all P < 0.05). In the random forest (RF) model, PD-L1 expression and TMB were the most influential predictors. The RF model demonstrated superior discrimination compared with the nomogram in both the training cohort (area under the receiver operating characteristic curve [AUC] 0.866 vs. 0.782; P < 0.001) and the internal validation cohort (AUC 0.769 vs. 0.669; P < 0.001), with better overall classification performance. In the temporally independent validation cohort, the RF model achieved an AUC of 0.757 (95% CI 0.682-0.902), a sensitivity of 82.6%, and a specificity of 76.2%, although the calibration was suboptimal.</p><p><strong>Conclusion: </strong>PD-L1 expression and TMB were independently associated with pathological response to neoadjuvant immunotherapy in patients with resectable lung cancer. The predictive model incorporating these biomarkers demonstrated acceptable performance, with the RF model outperforming the nomogram. However, the model should be considered exploratory and requires prospective multicenter external validation before routine clinical application.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"2082-2093"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148619480","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":"Comparative clinical evaluation of endothelin receptor antagonists in pulmonary arterial hypertension using a multi-criteria decision analysis framework.","authors":"Zihan Cao, Long Meng, Yunlong Li, Mi Zhou, Huiming Jiang, Jun Wang, Yi Tao, Feng Qiu","doi":"10.1007/s11096-026-02172-6","DOIUrl":"10.1007/s11096-026-02172-6","url":null,"abstract":"<p><strong>Introduction: </strong>Endothelin receptor antagonists are important therapies for pulmonary arterial hypertension, but differences in efficacy, safety, monitoring requirements, drug interactions, costs, and accessibility complicate treatment selection.</p><p><strong>Aim: </strong>To compare endothelin receptor antagonists across safety, efficacy, economic value, suitability, accessibility, and innovation, and to develop a multidimensional framework for clinical pharmacy decision-making and formulary management.</p><p><strong>Method: </strong>A structured framework was developed through a two-round Delphi process involving 19 multidisciplinary experts. Indicators were classified as quantitative or qualitative and organized into six domains. Consensus was assessed using the authority coefficient, coefficient of variation, and Kendall's coefficient of concordance. Weights were determined using the analytic hierarchy process and integrated through multi-criteria decision analysis. Quantitative evidence was derived from regulatory sources, randomized trial meta-analysis, national pricing databases, and hospital procurement records. Qualitative indicators, including monitoring requirements, drug interactions, adherence-related factors, accessibility, and innovation, were scored using predefined criteria. Economic value was evaluated in the Chinese healthcare context using annual drug acquisition costs, affordability ratios, and cost per metre improvement in 6-min walk distance.</p><p><strong>Results: </strong>The Delphi process established a framework comprising six domains, 13 subdomains, and 32 indicators, with good reliability and consistency: authority coefficient 0.82, Cronbach's alpha 0.864, and Kendall's W 0.412. Twelve randomized controlled trials were included in the quantitative synthesis. All endothelin receptor antagonists improved exercise capacity and hemodynamic outcomes, although the magnitude varied. Ambrisentan showed comparatively larger improvements in 6-min walk distance and a trend toward lower odds of adverse drug reactions. Annual drug acquisition costs were ¥24,600 for ambrisentan, ¥17,820 for bosentan, and ¥57,240 for macitentan. The corresponding costs per metre improvement were ¥140.12/m, ¥142.38/m, and ¥1470.71/m, and annual cost-to-income ratios were 87.15%, 63.13%, and 202.78%, respectively. After weighted integration, ambrisentan achieved the highest overall score, followed by bosentan and macitentan.</p><p><strong>Conclusion: </strong>Within the proposed MCDA framework, ambrisentan achieved the highest overall score across multiple clinical and practical dimensions. The framework provides a transparent tool for structured evaluation, although economic and accessibility findings should be interpreted within the Chinese healthcare context.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1947-1956"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630195","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}