International Journal of Clinical Pharmacy最新文献

{"title":"Development of a real-world, therapeutic drug monitoring-informed model to predict teicoplanin daily dose in pediatric intensive care unit patients with bacterial infections.","authors":"Fusang Wang, Mei Zhang, Suiwen Ye, Jianan Yan, Xuechun Li, Jinyuan Zhang, Xiaoxia Yu, Ying Wang, Ze Yu, Fei Gao, Junyan Wu","doi":"10.1007/s11096-026-02124-0","DOIUrl":"10.1007/s11096-026-02124-0","url":null,"abstract":"<p><strong>Introduction: </strong>Teicoplanin is commonly used to treat Gram-positive bacterial infections in the intensive care unit (ICU). However, evidence to support individualized therapeutic drug monitoring (TDM)-guided daily dosing of teicoplanin in pediatric ICU patients remains limited despite substantial interpatient variability in pharmacokinetics and clinical response.</p><p><strong>Aim: </strong>To develop and validate a real-world TDM-informed machine learning model to predict physician-adjusted teicoplanin daily dose in pediatric ICU patients, with the goal of supporting individualized dosing decisions in clinical pharmacy practice.</p><p><strong>Method: </strong>Clinical and TDM data from pediatric ICU patients receiving teicoplanin at the Sun Yat-sen Memorial Hospital of Sun Yat-sen University between June 2020 and June 2023 were retrospectively collected. The outcome variable was the daily teicoplanin dose administered during routine TDM-guided clinical care. After univariate screening and sequential forward selection, the dataset was divided into training and test sets (8:2). Missing values were imputed using the random forest approach. Nine machine learning and deep learning algorithms, including gradient boosting, XGBoost, LightGBM, and TabNet, were developed and evaluated using tenfold cross-validation, with model performance assessed using the coefficient of determination (R²), root mean square error (RMSE), and mean absolute error (MAE).</p><p><strong>Results: </strong>A total of 257 pediatric ICU patients (595 teicoplanin dosing records) were included in the study. Weight, age, height, teicoplanin trough concentration (TDM), glucose, creatine kinase isoenzyme-MB, total protein, concomitant imipenem and meropenem use, and upper respiratory infection were identified as key predictors. Among the nine models, the TabNet algorithm demonstrated the best performance on the test set (R² = 0.82, RMSE = 53.96 mg/day, MAE = 39.93 mg/day). The proportion of predictions within ± 30% of the observed daily dose was 81.51%.</p><p><strong>Conclusion: </strong>This real-world TDM-informed TabNet model shows strong performance in predicting the daily dose of clinician-adjusted teicoplanin in pediatric ICU patients. The model may serve as a clinical decision-support tool for pharmacists and physicians to assist individualized teicoplanin dosing within routine TDM workflows, potentially improving dosing consistency, and supporting safe and effective antimicrobial therapy.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1462-1475"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716554","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 predictive performance of anticholinergic burden scales for anticholinergic-related hospitalisation and emergency department visits in older adults: a population-based study of model development and temporal validation.","authors":"Valentina M Srikartika, David Youens, Rachael Moorin, Ninh Ha","doi":"10.1007/s11096-026-02145-9","DOIUrl":"10.1007/s11096-026-02145-9","url":null,"abstract":"<p><strong>Introduction: </strong>Anticholinergic burden scales are widely used to guide medication review in older adults, yet their ability to predict clinically important adverse outcomes remains uncertain, as most evidence is based on associations rather than validated risk prediction. In the absence of a gold standard, the clinical value of these scales depends on whether they can discriminate between individuals at risk and provide accurate absolute risk estimates.</p><p><strong>Aim: </strong>To compare the predictive performance of six anticholinergic burden scales for hospitalisation/emergency department (ED) visits related to anticholinergic adverse effects, assess internal and temporal validation of cognitive impairment models across scales, and examine the risk gradient across increasing anticholinergic burden levels for cognitive impairment across scales.</p><p><strong>Method: </strong>A retrospective cohort study using linked population-level administrative health data of adults aged ≥ 65 years in Western Australia (2015-2019). Development cohorts were from 2015-16 (N = 323,682) and 2016-17 (N = 334,304), and the temporal validation cohort was from 2017-18 (N = 330,684). Six anticholinergic burden scales were calculated annually. Logistic regression models with common predictor structure including demographic and clinical predictors were used to predict any hospitalisation/ED visit related to anticholinergic adverse events (falls/fractures/dizziness, cognitive impairment, or constipation/urinary retention). Model performance was assessed using the c-statistic, calibration slope, and Brier score. Cognitive impairment models were further evaluated using bootstrap internal validation (200 replications), temporal validation, and predicted risk estimation across exposure deciles.</p><p><strong>Results: </strong>Across initial model comparisons, Korean Anticholinergic Burden Scale (KABS) showed the highest c-statistics for each outcome, although between-scale differences were small. Cognitive impairment showed the highest discrimination across scales and was selected for further validation. In temporal validation, c-statistics for cognitive impairment ranged from 0.795 to 0.806, with the highest value observed for KABS, and calibration slopes ranging from 1.024 to 1.032 across scales. Predicted risk of cognitive impairment increased across exposure deciles for all scales, with the highest-decile risk ranging from 5.27% for TSDD-SAMS to 7.58% for KABS.</p><p><strong>Conclusion: </strong>KABS showed slightly higher and more consistent predictive performance than the other scales, particularly for cognitive impairment, although between-scale differences were modest. Presenting validated absolute risk estimates across exposure groups may improve clinical interpretability and support risk stratification, but wider validation and clinical judgement remain essential before routine use.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1646-1659"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716593","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":"Global burden shift from infectious to non-communicable neurological disorders in adolescents and young adults (10-24 years): findings from the global burden of disease study 1990-2021.","authors":"Tao Gu, Ruiqi Jiang, Yue Tian, Zhigang Zhao, Li Wang, Mingnan Cao","doi":"10.1007/s11096-026-02104-4","DOIUrl":"10.1007/s11096-026-02104-4","url":null,"abstract":"<p><strong>Introduction: </strong>Neurological disorders are a leading cause of disability and death worldwide; however, their age- and sex-specific patterns among adolescents and young adults remain poorly characterized. Understanding these trends is essential for developing targeted health strategies and optimizing pharmacotherapy in this population.</p><p><strong>Aim: </strong>This study aimed to assess global trends and sex-specific patterns in the burden of neurological and neurodevelopmental disorders among individuals aged 10-24 years from 1990 to 2021, providing evidence to inform clinical pharmacy practice and global health policies.</p><p><strong>Method: </strong>Data for 34 neurological conditions among individuals aged 10-24 years were extracted from the 2021 Global Burden of Disease database. Age-standardized prevalence and disability-adjusted life-year (DALY) rates were analyzed according to sex and disorders. Estimated annual percentage changes were derived using log-linear regression models. Joinpoint regression identified significant shifts in the temporal trends. Heatmaps were generated to rank disorders by prevalence and DALYs across global and specific regions. Analyses were conducted using R, version 4.4.3.</p><p><strong>Results: </strong>Between 1990 and 2021, infectious neurological diseases, including malaria, cysticercosis, rabies, meningitis, encephalitis, and tetanus, have declined substantially in both prevalence and DALYs. Conversely, perinatal and developmental disorders showed marked increases, particularly neonatal encephalopathy, preterm birth complications, and neonatal sepsis in both measures. Migraine and tension-type headaches remain the most prevalent conditions in 2021 with minimal temporal changes. Pronounced sex disparities emerged: multiple sclerosis increased more rapidly in females, while alcohol use disorders declined faster in males. Regional inequalities persisted, with infectious burdens concentrated in low- SDI areas, and chronic disorders predominant in high-SDI regions.</p><p><strong>Conclusion: </strong>Neurological disease burden among adolescents and young adults has transitioned from infectious to chronic, neonatal, and behavioral conditions, accompanied by significant sex-specific and regional differences. These results highlight the importance for youth-centered prevention, early diagnosis, and equitable access to care. Integrating pharmacists into multidisciplinary neurological care teams can enhance medication optimization, adherence support, and the long-term management of chronic neurological conditions, ultimately improving health outcomes in this vulnerable population.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1284-1302"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147493900","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 process evaluation of a clinical trial on bedside model-informed precision dosing of vancomycin in critically ill children.","authors":"Lise-Marie Kinnaer, Anca Amza, Pieter De Cock","doi":"10.1007/s11096-026-02112-4","DOIUrl":"10.1007/s11096-026-02112-4","url":null,"abstract":"<p><strong>Introduction: </strong>Model-Informed Precision Dosing (MIPD) is increasingly used to optimize vancomycin therapy in critically ill patients. However, process evaluations randomized controlled trials (RCTs) of MIPD remain rare, particularly in neonatal and pediatric intensive care. They provide however valuable insights about how and why interventions work.</p><p><strong>Aim: </strong>This study explored healthcare professionals' (HCPs) experiences with using the MIPD software for vancomycin during the BENEFICIAL-RCT in critically ill children and examined contextual factors influencing its use.</p><p><strong>Method: </strong>A qualitative descriptive exploratory study was conducted after the BENEFICIAL-RCT in 8 Belgian hospitals. Semi-structured interviews and focus groups were held between January and May 2025 with physicians, clinical pharmacists, clinical biologists, and trial nurses. Data were analyzed thematically.</p><p><strong>Results: </strong>Twenty-one HCPs participated. Four overarching themes emerged: enhanced clinical confidence and professional empowerment, experienced workflow barriers, clinical and healthcare-system implications and conditions for sustained MIPD-adoption. Participants described that beyond faster attainment of target AUC, the software fostered professional empowerment through its visualizations and the ability to retain final decision authority. Experiences also underscored how infrequent clinical exposure to adopting MIPD hindered continuity of MIPD expertise. This was pertinent in settings with low vancomycin case volumes or frequent rotating medical staff. As experienced workflow barriers especially the pivotal role of nurses in ensuring accurate documentation of sampling and infusion times was mentioned. These documentation uncertainties were perceived as affecting trust in the dosing workflow. Participants also highlighted night-time operational challenges for which workarounds set up during the RCT would not be feasible for routine practice. Concerning conditions for sustained MIPD-implementation, HCPs emphasized the importance of MIPD integration in electronic health records and automated dose calculation. The need for local MIPD champions was recurrently emphasized, particularly to support onboarding of new HCPs in MIPD.</p><p><strong>Conclusion: </strong>The results highlight that to support broader implementation of MIPD in pediatric critical care, hospitals should prioritize electronic record integration, streamline workflows, and appoint internal MIPD champions. These measures may reduce workload and errors, and support sustainable use in daily practice.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1359-1369"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147485717","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":"Evaluation of consistency in adverse event reporting between trial registry and publications in COVID-19 pharmacological intervention trials.","authors":"Mia Strikić, Shelly Melissa Pranić","doi":"10.1007/s11096-026-02130-2","DOIUrl":"10.1007/s11096-026-02130-2","url":null,"abstract":"<p><strong>Introduction: </strong>Complete and consistent reporting of adverse events (AE) affects decisions in clinical practice. We conducted a cross-sectional study aiming to assess transparency and completeness of reported adverse events from randomized clinical trials (RCTs) on pharmacological interventions, including biologicals, to treat Coronavirus disease 2019 (COVID-19) registered on ClinicalTrials.gov on or after January 1, 2020, and updated on or before May 31, 2021, along with corresponding publications.</p><p><strong>Aim: </strong>We aimed to assess the completeness and consistency of adverse event and all-cause mortality reporting between ClinicalTrials.gov and corresponding publications.</p><p><strong>Method: </strong>We conducted a cross-sectional comparison of safety reporting between ClinicalTrials.gov registry and peer-reviewed publications of RCTs investigating COVID-19 pharmacological interventions, including biologicals. Two authors evaluated RCTs to reach κ ≥ 0.80.</p><p><strong>Results: </strong>A total of 68 trials were assessed for discrepancies in adverse event and all-cause mortality data. Thirty-one (46%) were industry-funded, and 44 (65%) were double-blind randomized clinical trials. Forty-nine (72%) publications had discordant counts of serious adverse events (SAE) descriptions, 35 (51%) had discrepancies in the number of patients affected by SAE, and 11 (16%) omitted all-cause mortality compared to the records in the ClinicalTrials.gov registry.</p><p><strong>Conclusion: </strong>Discrepant reporting of AEs and essential trial data was high in trials on COVID-19 therapeutics.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1510-1518"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672897","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 scope of practice: a prescribing autonomy framework to support early-career prescribers.","authors":"William Swain, Michelle Styles, Ellen Schafheutle","doi":"10.1007/s11096-026-02144-w","DOIUrl":"10.1007/s11096-026-02144-w","url":null,"abstract":"<p><p>The introduction of pharmacist independent prescribing at the point of registration represents a profound shift in UK pharmacy practice. From 2026, newly qualified pharmacist independent prescribers will begin their careers with prescribing responsibilities but without the experiential consolidation or structured supervision pathways that underpin early prescribing in other professions. Existing governance mechanisms-particularly the concept of scope of practice-were designed for experienced, often specialist, prescribers and therefore fail to capture the dynamic decision-support needs of novice practitioners working across varied clinical contexts. Competency frameworks also provide limited insight into how prescribers negotiate uncertainty, collaborate with colleagues or calibrate clinical oversight in day-to-day practice. This commentary argues that these developments in the UK require an alternative approach to describing, governing and supporting prescribing practice, particularly at transition points. The Prescribing Autonomy Framework (PAF) proposes a context-sensitive framework that categorises prescribing decision-making into three levels of autonomy-low, medium and high-based on the degree of collaboration, protocol use, clinical oversight and digital decision-support required. By focusing on how prescribing decisions are reached rather than solely on what prescribers are authorised to prescribe, the framework offers a structured vocabulary for framing competence, informing support needs and surfacing risks. It also intersects with concepts of clinical complexity, accountability and risk, with the potential to support richer reflection and governance than existing approaches in the UK. While developed in response to changes in UK pharmacy training, the framework may have broader applicability. It offers a mechanism for supporting early-career prescribers across professions, guiding transitions into new areas of practice and strengthening healthcare governance. As prescribing roles expand internationally, the PAF aims to provide a scalable and adaptable approach to supporting safe, contextualised development of prescribing practice. The framework is presented as a theoretical governance lens and has not yet undergone empirical testing or formal validation.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1731-1736"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163191","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":"Fenofibrate discontinuation and the association with clinical outcomes in primary biliary cholangitis patients receiving combination therapy.","authors":"Shuhao Su, Jiaqi Yang, Jie Luo, Caiyun Yang, Chongxiao Li, Xingchen Liu, Guanya Guo, Ying Han","doi":"10.1007/s11096-026-02154-8","DOIUrl":"10.1007/s11096-026-02154-8","url":null,"abstract":"<p><strong>Introduction: </strong>Fenofibrate serves as a second-line therapy in combination with ursodeoxycholic acid (UDCA) for patients with primary biliary cholangitis (PBC). However, a substantial proportion of patients discontinue treatment in clinical practice.</p><p><strong>Aim: </strong>To characterize the biochemical and clinical associations of fenofibrate discontinuation and the changes observed upon re-initiation in PBC patients.</p><p><strong>Method: </strong>Patients receiving combination therapy with UDCA and fenofibrate were consecutively enrolled between January 2011 and March 2025. Fenofibrate discontinuation was treated as a time-dependent covariate: patients were classified as being in the continuation group from fenofibrate initiation until the date of first discontinuation. Treatment adherence was quantified using the medication possession ratio (MPR). The composite endpoint included decompensated cirrhosis, liver transplantation, and death.</p><p><strong>Results: </strong>Among 161 patients analyzed, 46 (28.6%) discontinued fenofibrate, and 31 of these later re-initiated treatment during follow-up. Patients were stratified into continuation and discontinuation groups, and no significant difference in the incidence of adverse events was observed. Discontinuation was associated with rapid biochemical relapse, with alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) levels significantly increasing within one month and the biochemical response rates declining from 59 to 25% at 12 months. Re-initiation of fenofibrate effectively reversed this deterioration. Time-dependent Cox analysis showed fenofibrate discontinuation was associated with a higher risk of clinical endpoint events (HR 2.57, 95% CI 1.12-5.91, P = 0.026). MPR showed an independent association with the risk of endpoint events and can be used to monitor patient medication adherence.</p><p><strong>Conclusion: </strong>Discontinuation of fenofibrate in patients with PBC is associated with rapid biochemical relapse and a trend toward unfavorable long-term outcomes. Maintaining treatment adherence is crucial, whereas timely re-initiation of therapy can effectively restore biochemical control.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1714-1724"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148054304","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":"Key performance indicators for hospital clinical pharmacy services: results of a global Delphi study.","authors":"Lucas Magedanz, Dayani Galato, Fernando Fernandez-Llimos","doi":"10.1007/s11096-026-02126-y","DOIUrl":"10.1007/s11096-026-02126-y","url":null,"abstract":"<p><strong>Introduction: </strong>The contribution of clinical pharmacy services (CPS) to patient outcomes and system performance is still not consistently measured. Most key performance indicators (KPIs) have been suggested only by pharmacists, without formal piloting or validation, and without benchmarking reference values. KPIs are indicators used to quantify pharmacists' clinical activities and their association with improvements in patient safety, therapeutic outcomes, and healthcare costs. There is a need for a globally informed, multi-stakeholder consensus on a core set of KPIs for hospital clinical pharmacy services that are explicitly outcome-based and suitable for international use.</p><p><strong>Aim: </strong>This study aimed to reach a consensus on a core set of KPIs for clinical pharmacy activities in hospital settings, achieved through a multi-stakeholder consensus process.</p><p><strong>Method: </strong>The 3-round Delphi technique was used to reach a consensus. Panellists were systematically selected from three groups of stakeholders: 'Clinical Pharmacy KPI Experts', 'Healthcare Systems Assessment Experts', and 'Patient Association Representatives'. The initial set of KPIs was based on themes identified in a previous review study. During the three rounds, the consensus thresholds increased from 60 to 70% and then to 80%. Panellists could suggest new KPIs and propose modifications to those already suggested.</p><p><strong>Results: </strong>Of the 480 potential experts initially identified, 342 valid email addresses were found, of which 49 (from 25 countries) committed to the Delphi study, including 22 clinical pharmacy experts, 21 patient representatives, and six healthcare systems assessment experts. A total of 43 panellists from 23 different countries completed the third round. Starting with 12 KPIs (plus one added in the first round), the panellists agreed on five KPIs, which were distributed as follows: Three clinical KPIs (adverse drug event rate, medication-related near miss event rate and medication goal achievement rate); one economic KPI (average optimised treatment cost difference); and one humanistic outcome KPI (patient satisfaction survey results). A manual containing the KPI information sheets was created.</p><p><strong>Conclusion: </strong>A global panel of stakeholders, including pharmacists, other healthcare professionals, and patient representatives, agreed on a core set of KPIs for hospital-provided CPS. This set comprises five measures covering three types of outcomes: economic, clinical, and humanistic.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1489-1499"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147591858","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":"Performance evaluation of large language models in real-world perinatal medication consultations: a cross-sectional study.","authors":"Ran Wang, Yifan Li, Xuewei Feng, Xin Feng","doi":"10.1007/s11096-026-02138-8","DOIUrl":"10.1007/s11096-026-02138-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Perinatal medication consultation is a core clinical pharmacy service that involves a complex benefit-risk assessment for both maternal and fetal safety. Large language models (LLMs) have emerged as potential tools to improve access to medication information, yet their performance and safety in real-world, pharmacist-led perinatal consultation settings, particularly in non-English contexts, remain insufficiently evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To evaluate and compare the performance of multiple advanced large language models in addressing real-world Chinese perinatal medication consultation queries and to assess their potential role as supervised adjunctive tools within clinical pharmacy services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;This cross-sectional study evaluated seven LLMs using real-world clinical data from pharmacist-led medication consultations at the Pharmacy Clinic of the Beijing Obstetrics and Gynecology Hospital, Capital Medical University. A standardized test set of 64 perinatal medication consultation questions was developed from 15,280 electronic consultation records collected between April 2014 and April 2024. The evaluated models included international (GPT-5.1, Grok 3, Gemini 3.0) and domestic (DeepSeek, Wenxin Yiyan, Kimi K2, Tongyi Qianwen) models. Senior clinical pharmacologists independently assessed responses across four dimensions-relevance, accuracy, usefulness, and empathy-using a 10-point Likert scale. Results are reported primarily as median (IQR), with mean ± SD additionally provided as a secondary descriptor to facilitate comparison with prior literature.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 448 model-generated responses, inter-rater consistency was excellent (ICC = 0.91, 95% CI 0.88-0.94). Significant differences in overall performance were observed among the models (Kruskal-Wallis H = 187.4, p &lt; 0.001; ε&lt;sup&gt;2&lt;/sup&gt; = 0.41, large effect). GPT-5.1 achieved the highest median total score [9.3 (IQR: 8.8-9.6); mean ± SD: 9.1 ± 0.8], outperforming all other models (all Bonferroni-corrected p &lt; 0.01; all r &gt; 0.50, large effect sizes), followed by Kimi K2 [8.5 (IQR: 7.9-9.1); mean ± SD: 8.4 ± 1.2] and DeepSeek [8.3 (IQR: 7.6-8.9); mean ± SD: 8.2 ± 1.1]. Tongyi Qianwen demonstrated the lowest overall performance [6.7 (IQR: 5.9-7.4); mean ± SD: 6.8 ± 1.3]. Accuracy was the primary determinant of performance differences. Performance gaps were more pronounced in complex clinical scenarios involving comorbidities or benefit-risk trade-offs, whereas domestic models demonstrated relative advantages in consultations involving traditional Chinese medicine.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;LLMs have demonstrated variable performance in response to perinatal medication consultation queries. While high-performing models show potential to support pharmacist-led perinatal medication consultations by improving access to information, their current performance supports use only as supervised, a","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1573-1584"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770761","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":"Incidence and duration of hospital-initiated opioids, benzodiazepines and antipsychotics: a retrospective cohort study.","authors":"Judith de Ruijter-van Dalem, Marjo J A Janssen, Johanna H M Driessen, Carl E H Siegert, Alex Marmorale, Daniala L Weir, Fatma Karapinar-Çarkit","doi":"10.1007/s11096-026-02152-w","DOIUrl":"10.1007/s11096-026-02152-w","url":null,"abstract":"<p><strong>Introduction: </strong>Many patients receive temporarily indicated medications, such as opioids, benzodiazepines, and antipsychotics (potentially inappropriate medications (PIMs) of interest) in hospitals. This could result in PIM use thereafter, when medication is continued.</p><p><strong>Aim: </strong>This study aimed to investigate the incidence and duration of hospital-initiated PIM use.</p><p><strong>Method: </strong>This retrospective cohort study included patients aged ≥ 18 years who visited a Dutch teaching hospital between January 2019-May 2023 and received a new prescription for an opioid, benzodiazepine, or antipsychotic initiated at discharge or outpatient visit and continued thereafter. Patients were followed for one year using data from the hospital's information system and community pharmacy dispensing records. The primary outcomes were the incidence of PIMs of interest and duration of use. Secondary outcomes included duration of PIM use across age categories and the proportion of prescriptions classified as actually inappropriate medication based on the documented indications in a subset of patients. Descriptive data analysis was used. Chi-square tests were used to assess differences between age categories and duration of continued use.</p><p><strong>Results: </strong>Among 6,835 patients with a new prescription of one of the medications, 82.7% were prescribed and dispensed an opioid (n = 5,652, mean age 61.1 years, 57.3% female), 14.7% a benzodiazepine (n = 1,005, mean age 60.7 years, 53.3% female) and 2.6% an antipsychotic (n = 178, mean age 69.2 years, 48.9% female). A significant proportion used the medication > 182 days following the hospital visit (13.4% opioids, 20.9% benzodiazepine, 36.0% of antipsychotics). PIMs were not more frequently discontinued in older adults. Among 156 randomly evaluated prescriptions, a clear justification for continued use was often lacking, mainly for benzodiazepines (83.1%) and opioids (76.0%).</p><p><strong>Conclusion: </strong>Potentially temporarily indicated medications were often continued following a hospital visit without justification for continued use. These results highlight the importance of carefully assessing the timely discontinuation or specifying a discontinuation date for PIMs.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1694-1702"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770831","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}