Data-Driven Clinical Pharmacy Research: Utilizing Machine Learning and Medical Big Data.

To conduct clinical pharmacy research, we often face the limitations of conventional statistical methods and single-center observational study. To overcome these issues, we have conducted data-driven research using machine learning methods and medical big data. Decision tree analysis, one of the typical machine learning methods, has a flowchart-like structure that allows users to easily and quantitatively evaluate the occurrence percentage of events due to the combination of multiple factors by answering related questions with Yes or No. Using this feature, we first developed a risk prediction model for acute kidney injury caused by vancomycin, a condition we frequently encounter in clinical practice. Additionally, by replacing the prediction target from a binary variable (i.e., presence or absence of adverse drug reactions) to a continuous variable (i.e., drug dosage), we built a model to estimate the initial dose of vancomycin required to reach the optimal blood level recommended by guidelines. We found its accuracy to be better than that of conventional dose-setting algorithms. Moreover, employing Japanese medical big data such as the claims database helped us overcome the major limitations of conventional clinical pharmacy research such as institutional bias caused by single-center studies. We demonstrated that the combined use of machine learning and medical big data could generate high-quality evidence leveraging the strengths of each approach. Data-driven clinical pharmacy research using machine learning and medical big data has enabled researchers to surpass the limitations of conventional research and produce clinically valuable findings.

Sentiment analysis in medication adherence: using ruled-based and artificial intelligence-driven algorithms to understand patient medication experiences.

BACKGROUND: Studies are exploring ways to improve medication adherence, with sentiment analysis (SA) being an underutilized innovation in pharmacy. This technique uses artificial intelligence (AI) and natural language processing to assess text for underlying feelings and emotions. AIM: This study aimed to evaluate the use of two SA models, Valence Aware Dictionary for Sentiment Reasoning (VADER) and Emotion English DistilRoBERTa-base (DistilRoBERTa), for the identification of patients' sentiments and emotions towards their pharmacotherapy. METHOD: A dataset containing 320,095 anonymized patients' reports of experiences with their medication was used. VADER assessed sentiment polarity on a scale from - 1 (negative) to + 1 (positive). DistilRoBERTa classified emotions into seven categories: anger, disgust, fear, joy, neutral, sadness, and surprise. Performance metrics for the models were obtained using the sklearn.metrics module of scikit-learn in Python. RESULTS: VADER demonstrated an overall accuracy of 0.70. For negative sentiments, it achieved a precision of 0.68, recall of 0.80, and an F1-score of 0.73, while for positive sentiments, it had a precision of 0.73, recall of 0.59, and an F1-score of 0.65. The AUC for the ROC curve was 0.90. DistilRoBERTa analysis showed that higher ratings for medication effectiveness, ease of use, and satisfaction corresponded with more positive emotional responses. These results were consistent with VADER's sentiment analysis, confirming the reliability of both models. CONCLUSION: VADER and DistilRoBERTa effectively analyzed patients' sentiments towards pharmacotherapy, providing valuable information. These findings encourage studies of SA in clinical pharmacy practice, paving the way for more personalized and effective patient care strategies.

Translation and validation of the CLEO tool in Vietnamese to assess the significance of pharmacist interventions.

BACKGROUND: There is currently no validated tool available for assessing the potential significance of pharmacist interventions in Vietnam. AIM: This study aimed to translate the CLEO tool from French into Vietnamese, validate the Vietnamese version, and demonstrate its feasibility in daily practice. METHOD: The CLEO tool was translated into Vietnamese (CLEOVN) using a 5-step process by bilingual experts. A total of 100 scenarios were compiled from clinical cases from nine hospitals evaluated by seven clinical pharmacists to determine inter-rater reliability and 30 out of 100 scenarios were re-evaluated one month later to determine test-retest reliability. Reliability was quantified using the intra-class correlation coefficient (ICC). A 20-item questionnaire on a 7-point Likert scale assessed the tool's appropriateness, acceptability, precision, and feasibility. RESULTS: Inter-rater reliability was good for clinical dimension (ICCA,1 = 0.71), excellent for economic dimension (ICCA,1 = 0.86), and fair for organizational/operational dimension (ICCA,1 = 0.56). Test-retest reliability scores were excellent for clinical (I̅C̅C̅A,1 = 0.79), excellent for economic (I̅C̅C̅A,1 = 0.84), and fair for organizational/operational (I̅C̅C̅A,1 = 0.56). The tool was rated as appropriate (mean = 5.86; SD = 1.03), acceptable (mean = 5.19; SD = 1.12), precise (mean = 5.71; SD = 1.17), and feasible (mean = 5.05; SD = 1.24). The maximum time required to evaluate an intervention was three minutes. CONCLUSION: The CLEOVN tool was successfully translated and validated for reliability, appropriateness, acceptability, precision, and feasibility. It will be suitable to evaluate the value of clinical pharmacy interventions.

Facilitators, Barriers, and Potential Impacts of Implementation of e-Pharmacy in India and its Potential Impact on Cost, Quality, and Access to Medicines: Scoping Review.

BACKGROUND: e-Pharmacy can potentially solve problems related to the quality of services and products, cost, and access to medicines in low- and middle-income countries. This review aims to understand the facilitators and barriers to the implementation of e-pharmacy in India. OBJECTIVE: This scoping review aimed (1) to understand the facilitators and barriers to the use of e-pharmacy in India and (2) to estimate the potential for e-pharmacy in India for improving access to medication, improving the quality of services and medicines, and decreasing costs of medications. METHODS: All published and gray literature from July 1, 2011, to June 30, 2021, relating to e-pharmacy, was searched from MEDLINE, Scopus, ProQuest, and Google using a systematic search strategy. RESULTS: In total, 1464 titles and abstracts were screened, of which 47 full-texts were included in the review. e-Pharmacy can potentially improve access to medications for remote areas, and old and debilitated individuals. e-Pharmacies can enable lean supply chain management, lower cost, and allow easy tracking of dispensed medicines. There is potential for integration of e-pharmacy services into the national program of Bhartiya Jan Aushadhi Pariyojana. However, the country is not adequately regulated to prevent the growth of illicit e-pharmacies. Lack of global accreditation and internet coverage, digital literacy, and transnational access are other challenges. CONCLUSIONS: E-pharmacy has the potential to improve universal health coverage in India by improving access to medicines and lowering the overall cost of health care. However, future growth will need specific regulations and accreditation mechanisms. TRIAL REGISTRATION: Open Science Forum; https://doi.org/10.17605/OSF.IO/6R9YQ.

Pharmacy 3D printing.

A significant limitation of the "one size fits all" medication approach is the lack of consideration for special population groups. 3D printing technology has revolutionised the landscape of pharmaceuticals and pharmacy practice, playing an integral role in enabling on-demand production of customised medication. Compared to traditional pharmaceutical processes, 3D printing has major advantages in producing tailored dosage forms with unique drug release mechanisms. Moreover, this technology has enabled the combination of multiple drugs in a single formulation addressing key issues of medication burden. Development of 3D printing in clinical applications and large-scale pharmaceutical manufacturing has substantially increased in recent years. This review focuses on the emergence of extrusion-based 3D printing, particularly semi solid extrusion, fused deposition modelling and direct powder extrusion, which are currently the most commonly studied in pharmacy practice. The concept of each technique is summarised, with examples of current and potential applications. Next, recent advancements in the 3D printer market and pharmacist perceptions are discussed. Finally, the benefits, challenges and prospects of pharmacy 3D printing technology are highlighted, emphasising its significance in changing the future of this field.

Gender Equity Perceptions among Social and Administrative Sciences Pharmacy Faculty: An AACP-APhA Task Force Report.

OBJECTIVE: The American Association of Colleges of Pharmacy's Social and Administrative Sciences (AACP SAS) Section and the American Pharmacists Association-Academy of Pharmaceutical Research and Science's Economic, Social and Administrative Sciences (APhA-APRS ESAS) Section formed a Gender Equity Task Force to determine if there is evidence to suggest that there is gender disparity in pay; responsibilities; treatment by peers/colleagues, students, and administration; leadership opportunities; rank, tenure status, and career advancement for Section members; and to develop recommendations to address existing disparities. METHODS: A Qualtrics survey was emailed in December 2020 to all AACP SAS and APhA-APRS ESAS Section members. The questionnaire included items regarding favorability toward men or women in various academic domains (research, teaching, service, recruitment, mentoring, and advancement). Participants were asked if they had experienced gender inequity, and if so, at what type of institution and academic rank. Chi-square tests of independence and post-hoc comparisons were used to assess item responses based on gender. RESULTS: Seventy-two percent of respondents indicated they had experienced gender inequity. Women and persons of color were more likely to do so. Women commonly reported that men received more favorable treatment in nearly all academic domains, whereas men reported that women and men were treated the same. CONCLUSION: Social and administrative sciences pharmacy faculty reported experiences of gender inequity and perceptions of gender equity. Perception gaps existed between male and female faculty in numerous academic domains. Colleges and schools of pharmacy should increase awareness of, and strive to self-assess, gender inequity in their institutions.

Evaluation of a student pharmacist-led depression screening program in a community pharmacy.

Introduction: One in 5 adults in the United States have depression and are at risk for suicide, the 11th leading cause of death in the United States. Community pharmacy settings are ideal for increasing access to mental health services. Our objectives were to assess PHQ-9 scores and evaluate participant satisfaction in a student pharmacist-led depression screening program in a community pharmacy. Methods: Student pharmacists trained in mental health first aid recruited participants 18 to 90 years old in a community pharmacy to complete the PHQ-9 and provided mental health education, referrals, and resources. A 2-week follow-up was completed, and participants reported on actions taken since the initial visit. Descriptive statistics, independent t tests, and χ 2 tests were used in data analysis. Results: Twelve depression screening events were held, and 70 participants completed the screenings. The mean age was 52 years, and 75.7% were female. PHQ-9 scores ranged from 0 to 24 with an average of 3.96. Most participants (92.9%) reported the depression screening program was helpful. More than 90% of participants completed the 2-week follow-up, and 92.3% reported being comfortable seeking mental health services from a pharmacist. About half (53.8%) reported reading the educational materials, 24.6% helped a friend or family member, and 16.9% made an appointment with their health care provider. Discussion: Student pharmacists successfully provided depression screenings and mental health education in a community pharmacy. Most participants had low PHQ-9 scores, found the program helpful, and are willing to utilize mental health services in a community pharmacy.

Pharmacy Students' Self-Reported Cultural Competence in a Pharmacy Curriculum by Academic Year.

OBJECTIVE: This study aims to explore results of a Cultural Competency Assessment of Pharmacy Students (CCAPS) survey to identify areas where cultural competence content in one college of pharmacy curriculum can be improved. METHODS: The 39-item CCAPS survey was developed and administered to Doctor of Pharmacy (PharmD) students from July 2022 (after the end of the didactic curriculum and at the beginning of experiential rotations for fourth-year students) through October 2022 (at the beginning of the Fall semester for first-year, second-year, and third-year students). Self-perception of cultural competency items were selected from the Cultural Competence Assessment Instrument and the Clinical Cultural Competency Questionnaire items. Responses were collected anonymously and analyzed in the aggregate by academic year using SPSS. RESULTS: Five hundred forty-one students participated, with ethnicities including White/European American (26.6%), East/South/Southeast Asian (17%, 18.5%, 5.4%), Arab/Middle Eastern (17.9%), African-American/Black (6.7%), and Hispanic (6.1%). Two-thirds of respondents identified as "very or extremely" culturally competent, and 78% reported comfort interacting with culturally diverse patients. Students scored lower on questions that assessed their comfort interacting with patients who have limited English proficiency or who refuse medications due to cultural reasons. Students in fourth year reported more difficulty practicing skills related to cultural competency in their daily life compared to students in other years. CONCLUSION: Using the CCAPS survey annually could help evaluate the cultural competency of pharmacy students across different academic years and identify gaps in the curriculum related to cultural competency.

Implementing a Letter Template to Expedite Specialty Medication Appeal Letter Submission.

BACKGROUND: Prior authorizations (PAs) for biologic medications, used to treat Inflammatory Bowel Disease (IBD), are often denied by Pharmacy Benefits Managers and can require a complex appeal process for patients to gain access to medication. OBJECTIVE: This quality improvement project evaluated the impact of implementing a standardized appeal letter template and customizable clinical rationale letter content on specialty pharmacist workflow and workload in an integrated Hospital Health System Specialty Pharmacy (HSSP) IBD clinic. PRACTICE DESCRIPTION: This initiative was conducted in an IBD outpatient clinic at a tertiary academic medical center with an integrated HSSP whose specialty pharmacists work collaboratively with providers to manage specialty medications. PRACTICE INNOVATION: A letter template was created in the electronic health record (EHR) for pharmacists to use when submitting appeal letters. The template automatically populates patient results from recent labs, imaging, and clinic visit notes as part of the appeal documentation. Clinical rationale letter content was developed for the most common appeal reasons using EHR functionality that allows the creation of standardized notes that can be shared among team members and customized at time of use. EVALUATION METHOD: An analysis of 2 months of data pre/post implementation was conducted using descriptive statistics to report the number of appeals submitted, time from PA denial to appeal submission, and appeal approval rate. A pharmacist post implementation satisfaction score was also collected. RESULTS: The number of appeals submitted pre- (n=73) and post-implementation (n=73) was the same. Post-implementation, 89% of appeals were submitted within 3 days of PA denial compared to 29% pre-implementation. PA approval rate was high (93%) pre- and post-implementation. Overall pharmacist satisfaction was 9.7 out of 10. CONCLUSION: Implementation of an appeal letter template and standardized clinical rationale letter content in the EHR led to decreased time to appeal submission and high specialty pharmacist satisfaction.

Empowering precision medicine: Insights from a national survey on pharmacogenomics knowledge, attitudes, and perceptions among community pharmacists in the UAE.

Background: Community pharmacists are essential to pharmacogenomics implementation because they can help trainers, clinical advisors, and other medical professionals understand the importance of pharmacogenomics and encourage them to use it in their practice. This study is to evaluate the community pharmacists' understanding, attitudes, and perceptions of pharmacogenomics in the United Arab Emirates (UAE). Methods: Professionals employed at community pharmacies in Abu Dhabi, Dubai, and the Northern Emirates participated in a cross-sectional study design. From July 2023 to February 2024, five pharmacy students in their last year conducted the survey. The study team employed a structured questionnaire to collect data in addition to conducting in-person interviews. The study questionnaire comprised three distinct sections namely, demographic information, knowledge of pharmacogenomics concepts, and perceptions regarding pharmacogenomics. Results: A total of 586 pharmacists enrolled in the study. The average knowledge score regarding pharmacogenomics was 75.1 % with a 95 % confidence interval (CI) of [72.4 %, 77.7 %]. The average attitude score toward pharmacogenomics was 67.5 % with a 95 % CI of [66.3 %, 68.7 %]. Better pharmacogenomics knowledge among several groups: independent pharmacies (OR 1.7; 95 % CI 1.2-2.4), Pharmacists in Charge (OR 1.4; 95 % CI 1.3-2.02), pharmacists with 11-15 years of experience (OR 2.1; 95 % CI 1.4-4.2), graduates from international universities (OR 4.6; 95 % CI 1.6-12.9), and those who received training on pharmacogenomics (OR 11.9; 95 % CI 3.3-14.5). Similarly, better attitude scores were observed among independent pharmacies (OR 1.5; 95 % CI 1.1-2.1), Pharmacists in Charge (OR 1.5; 95 % CI 1.07-2.1), pharmacists with 16-20 years of experience (OR 2.1; 95 % CI 1.16-3.7), graduates regional universities (OR 1.47; 95 % CI 1.05-2.1), and those who received training on pharmacogenomics (OR 4.8; 95 % CI 3.2-7.3). Conclusion: The positive attitudes toward pharmacogenomics that we found in our research indicate that community pharmacists in the United Arab Emirates are beginning to realize the potential advantages of pharmacogenomics in terms of improving patient care. Policies ensuring the privacy and confidentiality of genetic information are also necessary in considering concerns about the availability of genetic test results to insurance companies and potential employers.

Enhanced Pharmacy Service Delivery Through a Pharmacy Information System at a Medical Center: A Case Study.

INTRODUCTION: A pharmacy information system (PIS) is a crucial tool for preventing errors and enhancing patient safety. This study aims to assess the influence of a PIS on workflow and medication errors (MEs) within the pharmacy department of a medical city in Saudi Arabia. The analysis encompasses an evaluation of the current workflow within pharmacy modules (in-patient, out-patient, and clinical pharmacy modules) and an exploration of associated challenges and inefficiencies. METHOD: The study employed both qualitative and quantitative methodologies, incorporating structured interview techniques and the review of system records, such as logs, incident reports, and ME databases. RESULTS: Respondents recognized the benefits of the PIS, including the management of high-quality real-time data (26%), reduction of MEs (25%), acceleration of healthcare practices (23%), and absence of space-time constraints (14%). The study highlighted the role of PIS in addressing medication stock control and shortage issues, thereby improving overall medication availability. Furthermore, PIS significantly enhanced safety (93.3%), efficiency (80%), reliability, accuracy, ease of use (56.7%, 56.7%), and cost-effectiveness (53.7%). Following the implementation of the PIS, there was an increase in ME reporting, indicating improved error detection and management. CONCLUSION: The research revealed an increase in ME reporting rates in hospitals after PIS installation, attributed to improved medication management processes resulting in higher detection rates. As healthcare facilities increasingly embrace electronic medical records, the understanding of patient care quality will be significantly impacted. Consequently, further research is warranted to explore the role of PIS in reporting, detecting, analyzing, and mitigating MEs, as well as their influence on the work environment to promote a secure and efficient patient journey.

Describing the current landscape of pass/fail grading schemes within skills-based pharmacy curricula.

INTRODUCTION: Optimal methods for grading students in skills-based courses within pharmacy education have not been fully explored. This research aimed to assess the current landscape of pass/fail grading schemes within pharmacy skills-based courses and explore faculty perceptions of pass/fail grading schemes. METHODS: A 29-item, cross-sectional survey was electronically distributed to the American Association of Colleges of Pharmacy Laboratory Special Interest Group. The survey collected demographics, course grading schemes, faculty perceptions of student performance, and impact of implementing pass/fail grading schemes. Survey respondents were also invited to participate in semi-structured interviews, which were summarized due to limited participation. Descriptive statistics were used for analysis of survey data. RESULTS: Fifty-five participants responded to the survey, representing 23 pharmacy institutions. Most respondents (82 %) used a traditional grading system for final course grades in skills-based courses. Some respondents (40 %) used specification grading for skills assessment, and 64 % of respondents used pass/fail grading to assess specific skills. Most respondents perceived that the change to pass/fail grading either improved or made no difference in faculty workload, wellbeing, general faculty creativity, quality of feedback, timeliness of grading, grade grievances, and faculty preparation time. The main concern was decreased student motivation and engagement. Semi-structured interviews identified a need for specific, validated rubrics, importance of faculty buy-in, and lack of impact on faculty workload as a result of the change. Concerns about residency placement and student motivation were also identified. CONCLUSION: There is variability in grading schemes used within skills-based pharmacy curricula. Faculty perceptions of pass/fail grading schemes are positive overall. Considering the limited number of institutions utilizing this grading scheme, additional research is needed.

Don't worry, be APPE: Developing and refining a skills-based assessment of student preparedness for advanced pharmacy practice experiences.

BACKGROUND: The Accreditation Council for Pharmacy Education (ACPE) 2025 Standards charge pharmacy programs to assess student readiness for Advanced Pharmacy Practice Experiences (APPEs), but the method of assessment is not defined. This report describes the process of developing, implementing, and refining an APPE readiness assessment (ARA) that can be adapted to individual institutional needs and learning outcomes. EDUCATIONAL ACTIVITY: The ARA at The University of Texas at El Paso School of Pharmacy, a Hispanic-serving institution, is comprised of two practice areas: drug information and the Pharmacist Patient Care Process, each with multiple objective structured clinical examinations (OSCEs) to mimic how students will apply these skills in required APPE rotations. The ARA has been adapted for administration both virtually and in-person. Students are required to attain a 70 % average across all five OSCEs, with an opportunity to retest on any failed areas prior to progression into the APPE year. CRITICAL ANALYSIS OF THE EDUCATIONAL ACTIVITY: Since initial implementation in 2021, faculty experience and student performance informed changes to the assessment, rubrics, and integration of skills throughout the curriculum. The average overall ARA score was an 89.13 % in 2021 and ranged from 79.74 to 82.3 % in 2022-2024. Typically, less than 10 % of the class required re-testing, however, in 2023 16 % of the class had an ARA average less than 70 % requiring re-testing. Written skills are consistently the lowest performing area for students, potentially due to language discordance between students' preferred language and the language of the assessment.

Engine of Innovation in Hospital Pharmacy: Applications and Reflections of ChatGPT.

Hospital pharmacy plays an important role in ensuring medical care quality and safety, especially in the area of drug information retrieval, therapy guidance, and drug-drug interaction management. ChatGPT is a powerful artificial intelligence language model that can generate natural-language texts. Here, we explored the applications and reflections of ChatGPT in hospital pharmacy, where it may enhance the quality and efficiency of pharmaceutical care. We also explored ChatGPT's prospects in hospital pharmacy and discussed its working principle, diverse applications, and practical cases in daily operations and scientific research. Meanwhile, the challenges and limitations of ChatGPT, such as data privacy, ethical issues, bias and discrimination, and human oversight, are discussed. ChatGPT is a promising tool for hospital pharmacy, but it requires careful evaluation and validation before it can be integrated into clinical practice. Some suggestions for future research and development of ChatGPT in hospital pharmacy are provided.

Exploring a role for community pharmacists in the identification of alcohol-related liver disease: a qualitative interview study with professionals, patients, and the public.

AIMS: To explore the views and attitudes of professionals, patients and the public to a role for community pharmacists in the identification of alcohol-related liver disease (ArLD). METHODS: Semi-structured interviews were conducted with a purposive sample of patients with ArLD, members of the public, pharmacy staff, and clinicians managing patients with ArLD across the Wessex region of south England. The interviews explored experiences of alcohol, ArLD and health advice in pharmacies and elicited views of what a pharmacist role in identifying ArLD could entail and factors influencing this. Transcripts were analysed using reflexive thematic analysis. RESULTS: Twenty-six participants were interviewed and three themes were generated: (i) acknowledging, seeking help and engaging with a hidden problem; (ii) professional roles, boundaries and attributes; (iii) communication, relationships, collaboration and support. Participants reported key challenges to identifying people at-risk of ArLD. Offering testing for ArLD was perceived to motivate engagement but there were concerns about pharmacists performing this. A role was mostly seen to be finding people at-risk and engaging them with further care such as referral to liver services. This was perceived to require developing interprofessional collaborations, remuneration and training for pharmacy staff, and community-based liver testing. CONCLUSIONS: Professionals, patient and public participants recognized a role for pharmacists in the identification of ArLD. This was envisaged to incorporate educating pharmacy users about ArLD risk, and identifying and directly engaging those at-risk with liver and support services through development of interprofessional collaborations. The findings of this study support and can inform future work to develop this role.

Changes in Acute Care Pharmacist Prescribing and Laboratory Ordering over Time: CAPLET Study.

Background: In Alberta, pharmacists may obtain additional prescribing authorization (APA) and a practice identification number (PRAC-ID) for ordering laboratory tests. Pharmacists working within Alberta Health Services were mandated by the employer to attain APA by 2018, whereas laboratory ordering has been in place since 2009. Five acute care sites within the Calgary Zone had a computerized provider order entry (CPOE) system that allowed tracking of these activities. Objectives: To describe changes in prescribing and laboratory ordering by acute care pharmacists over time and to compare these activities across hospitals, sites, and specialty teams. Methods: A retrospective, descriptive review of acute care pharmacist orders for medications and laboratory tests was completed using data from the CPOE system for the period 2018 to 2021. Results: Over the study period, the rates of prescribing and laboratory ordering by pharmacists increased by 67.5% (from 1423 to 2383 per full-time equivalent [FTE]) and by 5.5% (from 235 to 248 per FTE), respectively. Pharmacists at the 5 hospitals increased their prescribing rates during that time (by proportions ranging from 7% to 176%). Cardiology, intensive care, and mental health teams had the largest increases in prescribing rates, whereas mental health, hospitalist, and intensive care teams had the greatest increases in rates of laboratory ordering. In each year of the study, the most frequently ordered medication for adult patients was vancomycin, and the most frequently ordered laboratory test was measurement of vancomycin before dose administration. The proportion of medication orders conveyed verbally decreased from 60.0% to 47.4% over the study period. Conclusions: The application of expanded scope of practice increased among acute care pharmacists, to a greater extent for prescribing than for laboratory ordering; however, the proportion of verbal medication orders remains high, a situation that should be addressed to improve patient safety. This study showed that prescribing and laboratory ordering are complementary, given that the top medications and laboratory tests were frequently related. The results of this study can be used for practice development and as the basis for further research within an expanded CPOE system.

Contexte: En Alberta, les pharmaciens peuvent obtenir une autorisation de prescription élargie (APE) et un numéro d'identification de pratique (PRAC-ID) pour demander des analyses de laboratoire. Les pharmaciens travaillant dans les Services de santé de l'Alberta ont été sommés par leur employeur d'obtenir une APE avant 2018, alors que les demandes d'analyses de laboratoire sont en place depuis 2009. Cinq sites de soins aigus dans la zone de Calgary disposaient d'un système de saisie informatique des ordonnances médicales (CPOE) permettant de suivre ces activités. Objectifs: Décrire les changements en matière de prescription et de demande d'analyses de laboratoire par les pharmaciens de soins aigus au fil du temps et comparer ces activités entre les hôpitaux, les sites et les équipes spécialisées. Méthodologie: Un examen rétrospectif et descriptif des prescriptions de médicaments et des demandes d'analyses de laboratoire effectuées par les pharmaciens en soins aigus a été mené à l'aide des données du système de CPOE pour la période 2018 à 2021. Résultats: Au cours de la période de l'étude, les taux de prescription et de demande d'analyses de laboratoire par les pharmaciens ont augmenté respectivement de 67,5 % (de 1423 à 2383 par équivalent temps plein [ETP]) et de 5,5 % (de 235 à 248 par ETP). Le taux de prescription des pharmaciens de tous les hôpitaux a augmenté au cours de cette période (de 7 % à 176 %). Les équipes de cardiologie, de soins intensifs et de santé mentale ont enregistré les plus fortes augmentations des taux de prescription, tandis que celles de santé mentale, de soins hospitaliers et de soins intensifs ont enregistré les plus fortes augmentations des taux de demande d'analyses de laboratoire. Chaque année de l'étude, la vancomycine était le médicament le plus fréquemment prescrit pour les patients adultes et les analyses de laboratoire les plus fréquemment demandées portaient sur la mesure de la vancomycine avant l'administration de la dose. La part des prescriptions de médicament communiquées verbalement a diminué de 60,0 % à 47,4 % au cours de la période d'étude. Conclusions: L'application d'un champ de pratique élargi a augmenté chez les pharmaciens de soins aigus, dans une plus grande mesure pour la prescription que pour les demandes d'analyses de laboratoire. Cependant, la part des prescriptions de médicament communiquées verbalement demeure élevée ­ une situation qui devrait être corrigée pour améliorer la sécurité des patients. Cette étude a démontré que les prescriptions et les demandes d'analyses de laboratoire sont complémentaires, étant donné que les principaux médicaments et les principales analyses sont fréquemment liés. Les résultats de cette étude peuvent être utilisés pour le développement de la pratique et comme base pour des recherches ultérieures au sein d'un système de CPOE élargi.

A Review of the Potential Role of Sotagliflozin: A Dual SGLT2 and SGLT1 Inhibitor-in the Treatment of Heart Failure.

Objective: This review provides an overview of the pharmacology, efficacy, and safety of sotagliflozin, a dual inhibitor of sodium-glucose cotransporters 1 and 2 (SGLT1 and SGLT2), to reduce the risk of cardiovascular death and hospitalization in those with heart failure. Data sources: A search of Embase via Elsevier, PubMed, Web of Science-All Databases, and The Cochrane Library for clinical trials in CENTRAL, as well as the MedRxiv and BioRxiv pre-print servers, was conducted from inception through December 1, 2023. Search terms included sotagliflozin, lx 4211, lp 802034, sar 439954, and (2S,3R,4R,5S,6R)-2-(4-chloro-3-(4-ethoxybenzyl)phenyl)-6-(methylthio)tetrahydro-2H-pyran-3,4,5-triol. Study selection and data extraction: Published phase 1, phase 2, and phase 3 clinical trials, meta-analyses, and systematic reviews. Studies were included if they were published in English and evaluated sotagliflozin pharmacology, pharmacokinetics, efficacy, or safety. Data synthesis: The Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure (SOLOIST-WHF) and Sotagliflozin on Cardiovascular and Renal Events in Patients with Type 2 Diabetes and Moderate Renal Impairment Who Are at Cardiovascular Risk (SCORED) phase 3 trials compared sotagliflozin with placebo in patients with type 2 diabetes mellitus. In both the SCORED and SOLOIST-WHF trials, treatment with sotagliflozin resulted in a statistically significant reduction in the primary composite outcome of death from cardiovascular causes, hospitalizations due to heart failure (HF), and urgent visits for HF. Conclusions: Dual SGLT1 and SGLT2 inhibition with sotagliflozin is efficacious in reducing myocardial infarction (MI), stroke, and HF hospitalizations and urgent visits in the SCORED and SOLOIST-WHF trials. However, its impact on reducing cardiovascular mortality remains uncertain due to premature study discontinuation. Owing to these factors and lack of generalizability, further studies are needed to establish its role in renal protection and cardiovascular mortality in broader populations. At this time, more evidence is warranted to definitively establish sotagliflozin in HF.

[Translated article] Prioritisation of 2024-2027 initiatives of the strategic Map for outpatient pharmaceutical care of the Spanish Society of Hospital Pharmacy.

OBJECTIVE: To prioritise the initiatives to be developed for the development of the Strategic Map of Outpatient Care (MAPEX) project to improve the quality of care and pharmaceutical care for patients seen in hospital pharmacy outpatient clinics in the period 2024-2027 in Spain. METHOD: The study was carried out in 4 phases between January and December 2023. For phase 1, a literature review of the evolution of the project was carried out by the coordinating committee with the aim of establishing a basis on which to define a new proposal for initiatives. In addition, an analysis was made of the health trends that will have an impact in the coming years. In phase 2, a working group of 19 specialists from all the autonomous communities was created, who were called regional ambassadors. They all made a preliminary proposal of initiatives and established revisions for their adjustment and final version both online and in telematic meetings. In phase 3, a consensus was established based on the Delphi-Rand/UCLA methodology with 2 rounds of online voting to select the initiatives classified as: priority and key or breakthrough. Between the first and second round of voting, a face-to-face "Consensus Conference" was held, where the results of the first round were presented. In phase 4, a public presentation was made in scientific forums and through the web. RESULTS: Ten trends in the health sector were identified. A list of 34 initiatives grouped into 5 lines of work was established. A total of 103 panellists participated in the first round and 76 in the second. Finally, 5 initiatives were established as priority and 29 as key. Among those prioritised were external visibility, adaptations to the CMO methodology, strengthening certification, and improving training. CONCLUSIONS: The initiatives agreed upon as priorities were aimed at improving professional visibility, broadening the methodology of care work, expanding the quality of care, enhancing the training of professionals, and the voice of patients.

Impact of a short-term pharmacy study abroad Program: student outcomes and program evaluation.

OBJECTIVE: This study examined the impact of a short-term study abroad program, focusing on program evaluation, attendee satisfaction, and acquired knowledge and skills. A questionnaire survey was conducted covering various aspects including demographics, program evaluation, and feedback. RESULTS: Results indicated higher female participation due to gender imbalances in pharmacy students in Egypt, with senior students recognizing the value of international experience. Attendee satisfaction was high, with positive feedback on accommodation, tours, and workshop materials. Field visits and workshops provided valuable experiential learning, with attendees suggesting extending the program's duration. The program equipped attendees with knowledge and skills relevant to pharmaceutical products and services, leading to improved competences and perceptions. The study concludes that such study abroad experiences profoundly impact personal growth and recommends integrating them into educational curricula for valuable experiences.

Using Politeness Theory to Deconstruct how Pre-registrant Pharmacists approach Disagreement in the Workplace.

OBJECTIVE: Using politeness theory, this study investigates how pre-registrant pharmacists engage in workplace disputes. METHODS: Fifty six students participated in two mock job judgement scenarios. In Scenario A (n = 25), the conflict was with a colleague of lower hierarchical status, while in Scenario B (n = 32), the conflict was with a colleague of equal hierarchical status. Using politeness theory, responses were coded into three tiers: 1) engagement in the face threatening act (FTA); 2) use of on/off record approaches; and 3) communicative strategies. For tier 1, reasons for engaging in the FTA were also coded. RESULTS: 89% of the participants indicated they would unequivocally engage in the FTA. For Scenario A, the pharmacist's roles and responsibilities (40%) and for Scenario B, situational urgency/safety (65%) were the key drivers. Scenario A participants were more likely to use an on-record approach (80%) than those in Scenario B (68%). Empathetic approaches (56%) were more common in Scenario A, while explanatory approaches (64%) were more frequent in Scenario B. CONCLUSION: This study shows that pre-registrant pharmacists are aware of the principles of face work. While the study only reflects what participants believe they would do, not their actual ability in professional disputes, it supports current research that students need simulated low-stakes opportunities to practise communication skills before entering the workplace, especially where situational urgency is present. Integration of politeness theory in workshop and feedback design could help students to link awareness to actual interaction, although the theory should be expanded to integrate urgency as a factor impacting on all levels of interactional decision-making.