International Journal of Clinical Pharmacy最新文献

{"title":"ADHD prescribing: national findings of children and adolescents attending mental health services in Ireland.","authors":"Etain Cantwell, Ivana Nelan, Sharifah Zahirah Idid, Suzanne McCarthy, David O Driscoll","doi":"10.1007/s11096-025-01979-z","DOIUrl":"https://doi.org/10.1007/s11096-025-01979-z","url":null,"abstract":"<p><strong>Introduction: </strong>Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition, which initially presents in childhood. While prescribing trends for treating ADHD have been previously examined in Ireland's paediatric population, off-label prescribing of ADHD medication has yet to be studied.</p><p><strong>Aim: </strong>We aimed to describe ADHD medication prescribing and off-label prescribing of ADHD medication in Ireland.</p><p><strong>Method: </strong>This cross-sectional study used a sample drawn from the population of children and adolescents who were attending mental health services in Ireland as of 31st December 2021. Participants were included based on predefined inclusion and exclusion criteria; those who were aged 17 years or younger and had been prescribed at least one psychotropic medication (n = 3,193). We described the frequency and population of those prescribed an ADHD stimulant or non-stimulant medication and the target condition or target symptom cluster for prescription. We reported the starting and maintenance doses of each medication.</p><p><strong>Results: </strong>Fifty-three percentage (n = 1,687) of children and adolescents were prescribed an ADHD medication on 31st December 2021, with more boys being prescribed an ADHD medication compared to girls (n = 1,284 vs n = 395). The most common age category prescribed ADHD medication was 11-13 years of age. The most common indication for prescribing ADHD medication was the target condition ADHD (n = 1,661; 98.5%).Twenty-six patients (1.5%) were prescribed ADHD medication for target symptoms, most commonly depressive (n = 8) and behavioural disturbance symptoms (n = 8) (i.e., off-label prescribing of ADHD medication).</p><p><strong>Conclusion: </strong>More than half of young people attending specialist mental-health services in Ireland were receiving an ADHD-specific medicine, and almost all prescriptions were tied to a confirmed ADHD diagnosis. Off-label use for other symptom clusters was rare (< 2%), indicating strong adherence to licensed indications but also highlighting the importance of continued surveillance to detect emerging off-label trends and to ensure prescribing remains evidence-based and patient-centred.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the role of community pharmacists in perioperative management of antithrombotic agents: a qualitative study of barriers, facilitators, and future directions.","authors":"Andreas Capiau, Isaura Kint, Els Mehuys, Tine De Backer, Annemie Somers, Koen Boussery","doi":"10.1007/s11096-025-01985-1","DOIUrl":"https://doi.org/10.1007/s11096-025-01985-1","url":null,"abstract":"<p><strong>Introduction: </strong>Antithrombotic agents are considered as high-risk medications, particularly during the perioperative period, because of the increased risk of bleeding. Balancing bleeding and thrombosis risks is crucial in the context of invasive procedures. The specific role of community pharmacists (CPs) in perioperative antithrombotic management remains unclear.</p><p><strong>Aim: </strong>This study aimed to explore the role of CPs in perioperative antithrombotic management, focusing on their experiences, and the barriers and facilitators to expand their involvement.</p><p><strong>Method: </strong>A qualitative study was conducted in Belgium between March and May 2024 using semi-structured, in-depth interviews with CPs. The Theoretical Domains Framework guided the development of the interview guide to ensure comprehensive coverage of relevant domains. Interviews were transcribed verbatim and analysed thematically using open and axial coding in NVivo 14 by two independent researchers. Participants were randomly sampled and recruited until no new themes were generated.</p><p><strong>Results: </strong>A total of 13 CPs (7 female; median age 48 years, IQR 34-58) participated in the in-depth interviews. Four key themes emerged: (i) current involvement of CPs in perioperative antithrombotic management, (ii) factors influencing CPs' role, (iii) aspirations and perceived opportunities for role expansion, and (iv) proposed strategies to optimise CPs' contributions. CPs described their current role as limited and mainly reactive, with their involvement typically occurring postoperatively. Reported barriers included insufficient knowledge of antithrombotic protocols, time constraints, inconsistent and non-transparent hospital guidelines, lack of access to relevant medical records, and difficulty reaching hospital-based prescribers. Facilitators included CPs' unique position to oversee a patient's full medication regimen, strong and trusted patient relationships, early post-discharge contact, and intrinsic motivation to contribute more actively. Participants expressed a desire for more proactive and collaborative involvement, supported by structured training. They also stressed the importance of clear, well-accessible guidelines that are as uniform as possible across hospitals. Lastly, they emphasised the need for better accessibility to prescribers to facilitate more effective communication.</p><p><strong>Conclusion: </strong>CPs' role in perioperative antithrombotic management is currently limited, particularly preoperatively. Addressing identified barriers and implementing the suggested improvements could strengthen their role. Further research is needed to validate these findings and guide future interventions.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences of people who inject drugs with hepatitis C testing and their perceptions of a pharmacy-based testing option: a qualitative study.","authors":"Cathy Balsom, Shawn Bugden, Lois A Jackson, Deborah Kelly","doi":"10.1007/s11096-025-01986-0","DOIUrl":"https://doi.org/10.1007/s11096-025-01986-0","url":null,"abstract":"<p><strong>Background: </strong>People who inject drugs (PWID) are at high risk of acquiring hepatitis C virus (HCV) infection, yet many remain undiagnosed due to testing barriers. Pharmacy-based point-of-care testing could improve access; however, little is known about its acceptability among PWID.</p><p><strong>Aim: </strong>To explore the experiences of PWID with HCV testing and their perceptions of a pharmacy-based HCV testing option.</p><p><strong>Method: </strong>A qualitative study involving interviews with eleven PWID between June and August 2022. Participants were asked about their perceptions and experiences about HCV testing as well as their views on a proposed pharmacy-based HCV testing model which was being proposed for a separate research study. Data were analyzed using reflexive thematic analysis.</p><p><strong>Results: </strong>Regarding their experiences with HCV testing, participants recognized the importance of testing to know their status both for their health and that of others. Several challenges to testing were described, and participants described the impact of the primary care provider on testing. It was suggested that opioid agonist therapy programs were a missed opportunity for testing, and many potential advantages to pharmacy testing were described. Privacy and confidentiality within the pharmacy, as well as the impact of the relationship with pharmacists and staff were key factors influencing uptake.</p><p><strong>Conclusion: </strong>Pharmacy-based HCV testing is viewed by participants as a convenient and acceptable testing option. Addressing stigma, ensuring privacy, and building trust with pharmacy staff appear to be critical for uptake. This approach may help to engage PWID in HCV testing as part of HCV elimination efforts.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and risk factors of acute kidney injury in patients with polypharmacy: a systematic review and meta-analysis.","authors":"Fengxue Yang, Linfang Zhu, Bing Cao, Hongli Miao, Li Zeng, Zhongqing Yuan, Yi Tian, Yuanting Li","doi":"10.1007/s11096-025-01988-y","DOIUrl":"https://doi.org/10.1007/s11096-025-01988-y","url":null,"abstract":"<p><strong>Introduction: </strong>Polypharmacy, typically defined as the use of five or more medications, has become increasingly common among older adults due to the rising prevalence of multimorbidity. While polypharmacy can be clinically necessary, it poses substantial risks for adverse drug events, including acute kidney injury (AKI). Drug-induced AKI accounts for a significant proportion of hospital-acquired cases and can result in prolonged hospitalization, increased healthcare costs, and higher mortality. Despite growing concern over these risks, the incidence of AKI associated with polypharmacy and the specific clinical and pharmacological factors contributing to this risk remain poorly quantified across different populations and setting.</p><p><strong>Aim: </strong>To estimate the incidence of AKI among adults exposed to polypharmacy and identify key drug-related and clinical risk factors.</p><p><strong>Method: </strong>A systematic review and meta-analysis were conducted and reported following PRISMA guidelines. We searched eight international and Chinese databases from inception to April 2025 for observational studies involving adults (≥ 18 years) receiving polypharmacy that reported AKI incidence or related risk factors. Eligible studies were assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis was used to calculate pooled AKI incidence. A narrative synthesis summarized the definitions of polypharmacy and identified associated risk factors.</p><p><strong>Results: </strong>Ten studies comprising over 302,000 participants were included; six studies provided data suitable for meta-analysis. The pooled incidence of AKI among patients exposed to polypharmacy was 18% (95% CI 2%, 45%). Key risk factors included high medication burden (≥ 5 or ≥ 10 medications), cardiovascular drug combinations, use of nephrotoxic agents, pre-existing renal impairment, frailty, and exposure to intensive care. Definitions of polypharmacy varied substantially across studies, including count-based thresholds, class-specific definitions, and risk-based exposure models.</p><p><strong>Conclusion: </strong>Polypharmacy is significantly associated with an increased incidence of AKI, particularly among hospitalized and clinically vulnerable individuals. The lack of standardized definitions for polypharmacy complicates evidence synthesis and cross-study comparisons. Standardized terminology and risk-adjusted prescribing practices are essential to improve medication safety and renal outcomes in at-risk populations.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating medication discrepancies and harm: a matched cohort study of collaborative pharmacist prescribing in a statewide healthcare system using electronic prescribing.","authors":"Hana Amer, Sally Marotti, Joshua M Inglis, Imaina Widagdo, Sharon Goldsworthy, Jacinta Johnson, Lisa Kalisch Ellett","doi":"10.1007/s11096-025-01996-y","DOIUrl":"10.1007/s11096-025-01996-y","url":null,"abstract":"<p><strong>Introduction: </strong>Collaborative pharmacist prescribing models involve pharmacists working with doctors and patients to develop medication plans and prescribe medications. Limited evidence exists on the impact of these models on medication discrepancies in hospitals using electronic prescribing systems (EPS).</p><p><strong>Aim: </strong>This study aimed to evaluate the impact of collaborative pharmacist prescribing on medication discrepancies and potential patient harm within a statewide healthcare system using EPS.</p><p><strong>Method: </strong>A multi-site matched cohort study involving 240 patients was conducted. EPS data for 120 patients aged ≥ 18 years who received collaborative pharmacist prescribing was matched 1:1 with 120 patients who received usual care of independent medical prescribing. Matching variables were hospital, clinical unit, sex, age, admission date, triage category and pre-admission medication count. The electronic medical record was reviewed to identify undocumented medication discrepancies, which were defined as any unexplained difference between the pharmacist-led medication history and medications prescribed on admission. The frequency of undocumented discrepancies was calculated. An independent multi-disciplinary clinician panel determined potential harm, using the Harm Associated with Medication Error Classification (HAMEC) tool.</p><p><strong>Results: </strong>There were fewer undocumented discrepancies per medication prescribed in the collaborative pharmacist prescribing group compared to usual care (RR 0.04, 95% CI 0.03-0.06) and the relative risk of undocumented discrepancies per patient was lower (RR 0.23, 95% CI 0.13-0.39). The expert clinician panel found that undocumented discrepancies rarely posed serious or severe harm in either group (0 undocumented discrepancies with potential to cause serious or severe harm in the collaborative pharmacist prescribing group compared to 8 in the usual care group).</p><p><strong>Conclusion: </strong>The implementation of collaborative pharmacist prescribing within a statewide EPS significantly reduced undocumented discrepancies and lowered the potential for patient harm. As healthcare systems globally shift towards electronic prescribing, this study provides timely and actionable evidence to inform policy and support the adoption of collaborative prescribing models in hospitals using EPS. Such models offer a practical strategy to improve medication safety, reduce patient harm and strengthen interprofessional collaboration at the point of prescribing.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world safety profile of mitomycin: signal detection and time-to-onset analysis from FDA adverse event reporting system and VigiAccess databases.","authors":"Zhenghua Hao, Linglu Yu","doi":"10.1007/s11096-025-01994-0","DOIUrl":"https://doi.org/10.1007/s11096-025-01994-0","url":null,"abstract":"<p><strong>Introduction: </strong>Mitomycin, a cytotoxic antitumor antibiotic, has been approved for the treatment of low-grade upper tract urothelial carcinoma (UTUC) and non-muscle invasive bladder cancer (NMIBC). It is also used off-label in ophthalmic procedures and gastrointestinal malignancies. Although the efficacy of mitomycin is well recognized, its safety profile, particularly regarding rare or serious adverse events (AEs), remains insufficiently characterized in large real-world populations.</p><p><strong>Aim: </strong>This study aimed to evaluate mitomycin-associated AEs through comprehensive analysis of two major global pharmacovigilance databases, with the goal of identifying high-risk organ systems and specific AE signals requiring increased clinical awareness.</p><p><strong>Method: </strong>AE data were retrieved from the FDA Adverse Event Reporting System (FAERS) covering Q1 2004 to Q3 2024. Data were deduplicated and standardized according to MedDRA terminology. Complementary data were collected from the World Health Organization VigiAccess database. Disproportionality analysis was performed using four signal detection algorithms: reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian confidence propagation neural network (BCPNN), and multi-item gamma Poisson shrinker (MGPS). The time-to-onset of adverse events was analyzed using non-parametric statistical methods.</p><p><strong>Results: </strong>A total of 1461 mitomycin-related reports, comprising 3652 AEs, were identified in the FAERS database. Notably, strong safety signals have emerged at the system organ class (SOC) level for eye, renal and urinary, blood and lymphatic system, and skin and subcutaneous tissue disorders. At the preferred term (PT) level, high disproportionality values were observed for serious events, such as scleral thinning (OR = 7129.60, 95% CI 4576.64-11,106.7) and bladder perforation (OR = 1585.69, 95% CI 1111.91-2261.33). Over two-thirds of AEs occurred within 30 days of drug administration, although 68.93% of the reports lacked valid onset-time data. The VigiAccess findings corroborated the SOC trends observed in FAERS.</p><p><strong>Conclusion: </strong>Mitomycin is associated with a broad range of organ-specific toxicities, many of which occur early in the treatment course and may have serious clinical consequences. This study highlights the need for early risk identification, individualized monitoring strategies, and greater pharmacovigilance in populations treated with mitomycin. These findings provide an important foundation for optimizing the safe and effective use of mitomycin in oncology and in other therapeutic settings.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Aged Care Onsite Pharmacist (ACOP) program in Australia: a qualitative study to examine key considerations for successful implementation in residential aged care homes.","authors":"Sara Javanparast, Daria S Gutteridge, Peter D Hibbert, Elizabeth Manias, Andrew C Stafford, Gregory M Peterson, Gillian E Caughey, Janet K Sluggett","doi":"10.1007/s11096-025-01991-3","DOIUrl":"https://doi.org/10.1007/s11096-025-01991-3","url":null,"abstract":"<p><strong>Introduction: </strong>The Aged Care Onsite Pharmacist (ACOP) program was recently launched in Australia to enable pharmacists to deliver clinical governance, clinical pharmacy and education services on the ground in residential aged care homes (RACHs). As the program is now being scaled up nationally, it is crucial to understand the complex interactions between various factors at the individual and organisational levels to ensure the program is successfully implemented and achieves its ultimate goal of improving the quality use of medicines in RACHs.</p><p><strong>Aim: </strong>This qualitative study aimed to explore stakeholders' perspectives on medication management, perceived value of onsite pharmacists, and key considerations for successful program implementation in RACHs.</p><p><strong>Method: </strong>We employed a qualitative approach and conducted semi-structured interviews (n = 61) with residents/families, pharmacists, medical practitioners, RACH staff, and individuals involved in policy and planning. Participants with experience working in both metropolitan and rural areas were included. The interviews were audio-recorded, transcribed, and thematically analysed, both inductively and deductively. The Consolidated Framework for Implementation Research informed the design of the study, developing interview schedules and data analysis.</p><p><strong>Results: </strong>Factors influencing the program implementation were grouped into five themes: (1) Individuals: factors concerning individuals involved in the program; (2) Innovation: factors related to the program design; (3) Process: implementation process actions; (4) Inner setting: factors relating to the organisational context; and (5) Outer setting: factors pertaining to the policy context. Most participants valued the potential contribution of onsite pharmacists. Program flexibility was noted as essential to increase its acceptability, uptake and adoptability. A desire for implementation strategies was evident. Workforce, organisational leadership, infrastructure and resources, and broader policy support were noted as critical for the program's success.</p><p><strong>Conclusion: </strong>The ACOP program represents a promising strategy to enhance medication management in RACHs. However, implementation on a large scale necessitates a thoughtful consideration of various interconnected factors at the individual, organisation and policy levels that may affect its uptake, adoptability, and long-term sustainability. This has implications for policymakers and providers at the scale up phase to ensure the program achieves its ultimate goal of enhancing residents' health outcomes.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community pharmacists' practices and clinical reasoning towards hospital discharge prescription: a study using simulations and retrospective think-aloud methodology.","authors":"Léa Solh Dost, Bertrand Guignard, Giacomo Gastaldi, Aveen Hasan Hamzo, Mathieu Nendaz, Marie-Claude Audétat, Marie P Schneider","doi":"10.1007/s11096-025-01978-0","DOIUrl":"https://doi.org/10.1007/s11096-025-01978-0","url":null,"abstract":"<p><strong>Background: </strong>The roles of community pharmacists have evolved from dispensing medications to clinical decision makers. This shift requires a clearer understanding of pharmacists' clinical reasoning. Managing hospital discharge prescriptions requires analytical reasoning to ensure patient safety through medication reconciliation and patient education.</p><p><strong>Aim: </strong>This study assessed community pharmacists' practices and their clinical reasoning towards hospital discharge prescriptions.</p><p><strong>Method: </strong>This mixed-method study consisted of two phases. First, community pharmacists participated in a simulated encounter in their pharmacy, where a patient presented a discharge prescription. Their practices and the structure of the encounter were assessed using a structured checklist of practices adapted from the MEDICODE checklist. Following the simulation, participants verbalised their thought processes in a retrospective think-aloud session. These semi-structured interviews were transcribed and analysed using both inductive and deductive qualitative methods. Charlin et al.'s model was used to assess clinical reasoning, while the Calgary-Cambridge model evaluated communication structure.</p><p><strong>Results: </strong>Among 14 participating pharmacists, 13 performed medication reconciliation, and 10 contacted the simulated prescriber to address discrepancies. While most provided adherence aids, only seven assessed non-adherence, and five actively collaborated with the patient. Pharmacists exhibited diverse interview structures, often revisiting previous discussion points. Clinical reasoning misconceptions, such as assumptions or premature closure, were observed at multiple stages of the clinical reasoning process.</p><p><strong>Conclusion: </strong>Community pharmacists demonstrate strong medication-related skills but face challenges in clinical reasoning for discharge prescriptions. Clinical reasoning training, semi-structured consultations, and greater patient engagement would help tailor and improve post-discharge care.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a machine learning-based risk prediction model and analysis of risk factors for docetaxel-induced bone marrow suppression in breast cancer patients.","authors":"Hongya Ou, Zijan Tan, Anle Shen, Liting Yu, Yibo He, Ri Hong, Xiaoru Lin, Xiaofeng Shi, Konglang Xing, Xiaoli Song, Yonglin Liu, Lingli Zou, Junyu Li","doi":"10.1007/s11096-025-01989-x","DOIUrl":"https://doi.org/10.1007/s11096-025-01989-x","url":null,"abstract":"<p><strong>Introduction: </strong>Breast cancer is the most prevalent malignancy in women worldwide. Docetaxel-based chemotherapy is commonly used for treatment, but its clinical application is often constrained by hematologic toxicity, particularly severe bone marrow suppression. The early identification of high-risk patients is essential to prevent complications and optimize therapeutic outcomes. Machine learning offers advanced capabilities for risk prediction by capturing complex patterns beyond those of traditional statistical models.</p><p><strong>Aim: </strong>This study aimed to identify the risk factors associated with bone marrow suppression in breast cancer patients receiving docetaxel-based chemotherapy, and to develop and validate predictive models using machine learning algorithms.</p><p><strong>Method: </strong>This retrospective case-control study included 119 patients with breast cancer treated with docetaxel-based chemotherapy at the Hainan Hospital of Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, from January 2020 to December 2024. Patients were divided into bone marrow suppression (n = 57; WHO grades II-IV) and non-suppression (n = 62; grades 0-I) groups based on WHO toxicity criteria. Multivariate logistic regression was used to identify independent risk factors. Three prediction models, logistic regression, random forest, and AdaBoost, were constructed and evaluated. A five-fold cross-validation with 50 repetitions was performed to ensure model stability and reliability.</p><p><strong>Results: </strong>Multivariate analysis revealed that a low baseline lymphocyte count (OR = 4.95, 95% CI 1.62-17.0), decreased white blood cell (WBC) count (OR = 0.62, 95% CI 0.40-0.9), and reduced prealbumin level (OR = 0.98, 95% CI 0.97-0.99) were significantly associated with severe bone marrow suppression (all p < 0.05). Among the models, AdaBoost achieved the best overall performance (AUC = 0.81; specificity = 94%; accuracy = 77%). The random forest model showed the highest sensitivity (83%), while logistic regression was more interpretable but demonstrated a lower predictive ability (AUC = 0.69).</p><p><strong>Conclusion: </strong>Pretreatment lymphocyte count, WBC count, and prealbumin level are reliable predictors of docetaxel-induced bone marrow suppression. The AdaBoost model demonstrates high specificity (94%) in identifying low-risk patients, supporting accurate risk stratification and personalized care in breast cancer treatment.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does direct oral anticoagulant lead-in dosing following initial parenteral therapy affect clinical outcomes in acute venous thromboembolism?: A retrospective cohort study.","authors":"James Kim, Kiyan Heybati, Emily Thompson, Somanshu Sharma, Drew Barron, Hannah Reynolds, Maryann Mirzakandov, Kate Norville, Jenna Reynolds, Harn J Shiue","doi":"10.1007/s11096-025-01993-1","DOIUrl":"https://doi.org/10.1007/s11096-025-01993-1","url":null,"abstract":"<p><strong>Introduction: </strong>Initiation of direct oral anticoagulants (DOAC) for the management of venous thromboembolism (VTE) typically includes a lead-in dosing phase. However, some patients may receive a shortened course due to comorbid conditions and/or numerous days of parenteral therapy. Limited data exist on the outcomes of an abbreviated lead-in therapy regimen.</p><p><strong>Aim: </strong>To investigate the clinical outcomes of patients receiving abbreviated versus standard/non-abbreviated DOAC lead-in regimens following parenteral anticoagulation therapy for VTE.</p><p><strong>Method: </strong>We conducted a retrospective cohort study including adults (≥ 18 years of age) who were admitted for acute VTE between 04/01/2019 and 12/31/2023 and received ≥ 24 h of parenteral anticoagulation before being transitioned to a DOAC with abbreviated versus non-abbreviated DOAC lead-in dose. The primary outcome was death or readmission from a thrombotic event within 30 days of discharge. Data were presented using descriptive statistics, logistic regression, and time-to-event analysis.</p><p><strong>Results: </strong>Across 590 patients, the median (IQR) age was 67 (58-76) years and 280 (47.5%) were female. Over half had a pulmonary embolism (54.9%; N = 324), 21.0% (N = 124) had a deep vein thrombosis, and the remainder experienced a combination. Most patients received the non-abbreviated lead-in dose (83.2%; N = 491). When compared to the non-abbreviated cohort, a higher proportion of those who received an abbreviated lead-in therapy had prior VTE and heart failure. There were no significant associations between an abbreviated lead-in dose and the primary outcome (aOR 0.44; 95% CI 0.13-1.52; P = 0.20). Bleeding events were also similar between the abbreviated and non-abbreviated dose cohorts at the longest follow-up (3.0%, N = 3 vs. 2.9%, N = 14; P = 0.92; aOR 0.82; 95% CI 0.22-3.1; P = 0.77) and within 30 days of DOAC initiation (HR 1.24; 95% CI 0.26-5.82; P = 0.79).</p><p><strong>Conclusion: </strong>An abbreviated DOAC lead-in therapy was not associated with short-term mortality, readmission due to recurrent thrombosis, or bleeding. Further prospective studies are needed to confirm these findings and provide insights into more personalized regimens.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}