This study aimed to assess the ability of community pharmacists to recognize cases of Loperamide abuse at the point of sale, their perspective of and experience towards potential abuse cases. Methods: A cross-sectional study was conducted in Jordan, using a self-administered online questionnaire. The questionnaire consisted of 3 main parts: demographics, the experience of pharmacists with abusers' behavior, as well as their perspectives towards Loperamide abuse. Results: A total of 250 community pharmacists completed the survey, 54% (135) of which were female. Almost one-third (33.2%; 83) of the participants reported exposure to suspected cases of Loperamide abuse during the last six months. Pharmacists declared that most of the suspected Loperamide abusers were male (60.2%), of middle-low socioeconomic status (69.9%), and between 20-30 years of age (57.8%). The largest quantity (packs) of Loperamide requested by a single patient was around 33.2±14.9 at once. As reported by pharmacists, the suspected reasons behind Loperamide abuse included 50% seeking euphoria, 17% relieving anxiety, and 33% controlling addiction (weaning off other opioids). The multivariate logistic regression analysis demonstrated a significant correlation between male gender (OR=1.2, 95% CI 0.12-1.59), pharmacy location in the center of Jordan (OR=21.2, 95%CI 2.45-183.59), late-night working shift (Shift C, OR=1.29, 95% CI 0.12-2.08) and abuse to Loperamide during the last six months. Conclusion: This study shed light on Loperamide abuse which is highly influenced by different sociodemographic characteristics. Accordingly, close monitoring and thorough tackling of the abuse practices are mandated through an increase in educational and awareness campaigns about proper medication use.

Polypharmacy and malnutrition are common health issues among older adults. In older people, there is a high prevalence of polypharmacy and malnutrition, and preliminary data also indicates that there is a significant of Food Supplements (FS) use, increasing the risk of duplication of thera-pies and several adverse reactions and drug-FS and FS-FS interactions. The intervention of health professionals in mitigating these risks is essential. This review not only underscores and discusses the potential association between polypharmacy, malnutrition, and food supplements but also presents current scientific evidence on polypharmacy, malnutrition, and the use of food supplements by the elderly. The work reviews the challenges, advantages and risks of using FS for the elderly who are polymedicated and/or malnourished, focusing on the good practices needed to support healthy ageing. In this regard, the paper intends to help health professionals better deal with the issue of polypharmacy and the use of multiple FS to overcome the malnutrition problem and improve the health and well-being of older adults.

(1) Background: Travel medicine practice has not been a part of practice in the community pharmacies in Japan. However, it’s getting more common for pharmacists to run travel clinic in North America. With ongoing globalization, Japanese pharmacists might be practicing travel medicine in future. This descriptive study is to examine the current knowledge, attitudes, and practices among Japanese community pharmacists. (2) Methods: Invitation to the study was sent to all pharmacies or corporates listed on Nippon Pharmacist Association member list plus one another large size pharmacy chain that was not member of NPhA. Community pharmacists working under those companies received a weblink to the survey. The survey was conducted from June to July 2017 by online questionnaire. (3) Results: The self-declared knowledge level of infectious diseases as well as travel vaccinations was generally low. The frequency of correct answer of the antibiotic resistance in South East Asia was 48.5%. Knowledge level of qunine resistance to Plasmodium falciparum malaria in Ghana and Nicaragua was very low. (4) Conclusions: Japanese community pharmacists are not familiar with travel related infectious diseases and vaccines used in travel medicine. The knowledge on the antibiotic resistance in traveler’s diarrhea and malaria prophylaxis was all low that is consistent with low degree of exposure to travel health questions from patients in daily practice and low percentage of intention to earn travel health certificates.

Research is scarce regarding antimicrobial use and antimicrobial resistance (AMR) for specific localities in Northern Ireland (NI). Additionally, the effects of COVID-19 on antimicrobial pre-scribing patterns and AMR are unknown. Between the European Union (EU) and United States (US), AMR causes approximately 68,000 deaths annually. This study will provide a better understanding of antimicrobial use and prescribing patterns in Belfast and link with AMR. An electronic survey was developed and distributed to eighty-five community pharmacists in Belfast. Yearly and monthly prescription data was gathered from the Business Services Organisation and COVID-19 statistics from Gov.uk. All data was analysed on Microsoft Office Excel® and IBM® SPSS® Statistics 25. Overall response rate was 46%. Most pharmacists (82%) failed to address prescriber non-compliance with guidelines and antimicrobial dosing errors (59%). The most common in-dication for antibiotics was upper respiratory tract infections (URTIs). Overprescribing of anti-biotics was perceived as the leading cause of AMR, therefore 69% of pharmacists indicated in-creased General Practitioner (GP) compliance with guidelines would reduce AMR. Pharmacists’ are in an ideal position to reduce AMR through patient education however, it is demonstrated that pharmacists failed to adequately counsel patients on antibiotic use. All GP practices demonstrated inappropriate antibiotic use, especially for URTIs which suggests antibiotic appropriateness should be reviewed. Many patients avoided contact with GP’s during COVID-19 which may have resulted in reduced antibiotic use. This research established amoxicillin as the most commonly prescribed antibiotic, which is contributing to increased AMR with its broad-spectrum activity and has recognised a decrease in antibiotic prescribing during COVID-19. Based on the results found and a critical review of the literature it is recommended antimicrobial guidelines should be re-viewed and improved, enhanced training should be provided to pharmacists and the antibiotic guardian (AG) campaign should be reenergised.

Introduction: Pharmaceutical products are inevitable for human health. Owing to the growing need for pharmaceuticals, pharmaceutical companies introduce drugs annually into the market in addition to the extensive collection of existing pharmaceutical products. Households, farms, health facilities, and pharmaceutical industries release pharmaceutical waste into the environment at low concentrations through routine pharmaceutical use, damage, and expiry. The effects of active pharmaceutical ingredients (API) on non-target species in the environment are not known. Over the years, pharmaceuticals such as diclofenac and ibuprofen in trace amounts have been detected in public water systems, ground and surface water. Unwanted medicines should be safely disposed of at a reduced financial cost to mitigate the public and environmental health risks. Lack of general knowledge of how to dispose of unused pharmaceuticals leads to improper disposal resulting in accidental toxicity, rising healthcare costs, landfills pilfering/scavenging, water supply pollution, anti-microbial resistance, and death. To mitigate such effects, pharmacists should raise public awareness about safe disposal practices. Objective: This review aims to examine the sources of pharmaceutical waste, disposal costs, secure disposal methods, the effects of inappropriate disposal, and the role of pharmacists in the disposal. Method: The information on the stated objectives was gathered from available sources through a comprehensive literature review. Conclusion: Many countries contain tons of pharmaceutical waste that are expensive to destroy. Because of improper disposal, pharmaceutical waste has been found at trace amounts in drinking and surface water. A practical, environmentally sustainable approach to pharmaceutical waste management, with policies and guidelines, and public awareness campaigns, are necessary to address the problem of safe waste disposal. The national drug regulatory bodies should conduct environmental risk assessment resulting from the disposal of unwanted pharmaceuticals. Pharmacists should facilitate extensive training on sustainable drug use and proper pharmaceutical waste disposal at all levels to reduce the risks associated with improper disposal. Reduction of pharmaceutical waste generation at each step of a drug’s lifecycle, implementing takeback options, collection at approved sites, and modern technology to treat wastewater are highly recommended to reduce the effects of unwanted pharmaceuticals on human health and the environment.

Abstract Introduction: Antimicrobial resistance (AMR) is a recognised public health threat today globally. Though many active and passive stewardship strategies are employed to counter AMR clinically, educating school going children on AMR could be a futuristic cost-effective measure to minimize AMR development. We hypothesised NICE’s e-bug module to class VII school students on AMR determinants. Methodology: A prospective non-randomized intervention study on 327 students belonging to 9 schools of class VII around Manipal town, Udupi district, Karnataka state, India were included for the study. 10 questions on AMR determinants extracted from NICE’s e-bug program were quizzed in written as pre-test followed by an education intervention on the same questions followed by a post-test to end the session. Descriptive statistics to estimate epidemiological characteristics, Wilcoxon Signed Ranks and Kruskal-Wallis tests were applied to analyse statistical significance of pre/post-test performance scores for the 10 questions and between schools respectively Results: Students had inadequate knowledge on 7 AMR determinants (antimicrobial indication, its course, hand hygiene, fermentation, spread of infection, microbial multiplication and characteristics of microbe) when analysed for post-test performance (p<0.05). Comparison of post-test performance of 9 participating schools revealed statistical significance (p<0.05) for 3 questions (definition on antimicrobial, cover while cough/sneezing and microbial characteristics) Conclusion: Although students exhibited sub-optimal knowledge on few AMR determinants, they showed keenness to learn exhibited by their performance. Our findings and previous similar studies from Europe are suggestive of early pedagogic interventions on AMR through inclusion of such education modules in the curriculum could be potential tool for AMR prevention for future generations.

1) Public health remains a tiny portion of the undergraduate pharmacy curriculum and the material is integrated into other modules. The objective of this study is to describe the UK undergraduate pharmacy curriculum, including its public health content; 2) Methods: A qualitative method (content analysis of websites) was used to describe the UK undergraduate pharmacy curriculum and teaching and learning policy. This involved selecting relevant concepts and then quantifying their presence and the relationships between them. The NVivo software was used to carry out ‘group queries’ and visualisation of results; 3) Results: Public health remains an optional module in the curricula of many UK schools of pharmacy. Several public health-related topics are often integrated into other modules, but UK undergraduate pharmacy curricula are still dominated by traditional pharmacy modules; and 4) Conclusions: Most of the curricula analysed were dominated by traditional pharmacy modules designed to enhance students' knowledge and skills. The skill set of UK pharmacy students with respect to macro-level public health activities needs to be improved in order to enhance pharmacists’ contribution to public health.

Background: Upper respiratory tract infections (URTIs) are a major public health concern due to their high incidence and potential for complications. Pharmacists often serve as the first point of contact for patients with URTIs. This study aims to develop and evaluate the RESP-8 tool to assist pharmacists in determining the need for medical evaluation. Methods: This prospective interventional cohort study was conducted over six months (October 2023 to March 2024) in community pharmacies. Participants included adults aged 18 years and older presenting with URTI symptoms. Pharmacists used the RESP-8 tool, which comprises eight criteria to assess the need for medical referral. Data on medical history, symptom duration, and progression were recorded. The primary outcome was the feasibility of implementing the RESP-8 tool. Secondary outcomes included the accuracy of the tool, the percentage of patients recommended for medical evaluation, and compliance with these recommendations. Results: A total of 64 participants were included, with an average age of 55.7 years. Pharmacists recommended medical evaluation for 75% (48/64) of patients using the RESP-8 tool. Among these, 70.83% (34/48) complied with the recommendation. The tool demonstrated high accuracy in identifying patients needing further medical evaluation, with only two noted errors. All compliant patients received appropriate treatment without complications. The tool was easy to implement, taking less than 5 minutes per patient. Discussion: The RESP-8 tool effectively guided pharmacists in recommending medical evaluations for URTI patients. The high compliance rate indicates patient trust in pharmacists' guidance. While the study's small sample size limits generalizability, the results are promising. Future studies with larger populations are necessary to validate these findings and further refine the tool. Conclusion: The RESP-8 tool shows potential in enhancing pharmacists' ability to make informed decisions about medical referrals for URTIs, ultimately improving patient outcomes and optimizing healthcare resource management.

Pharmacists must acquire the necessary knowledge to provide better drug therapy to patients. In other words, educational programs need to facilitate behavioral changes among pharmacists. Therefore, this study aimed to evaluate how the behavior of pharmacists changed after attending a palliative care educational program. We conducted a web-based questionnaire survey examining the behavior of pharmacists regarding palliative care before participating in the program, two months after participating in the program, and eight months after participating in the program, to determine the behavior and changes over time. For all questions, scores were higher at two and eight months after attending the program than before attending the program (P &lt;0.05). In addition, no significant difference was observed between two and eight months after attending the program for all questions (P =0.504-1.000). The knowledge gained from the educational program was used to repeatedly intervene with patients with cancer, to address the various symptoms they experienced and maintain their behavior. The proven effectiveness of this program serves as a stepping stone for a nationwide rollout across Japan’s 47 prefectures.

The article "Ensuring Quality Medicine is Not a Single Event but a Combined Effort of a Pharmaceutical Company" explores the multifaceted approach required to maintain high standards in pharmaceutical manufacturing. It emphasizes that quality assurance in medicine production is not an isolated event but a continuous, integrated process involving multiple departments and stages. The article highlights the roles of research and development, rigorous clinical trials, regulatory compliance, and robust manufacturing practices in ensuring the efficacy and safety of medicines. It also discusses the importance of quality control measures, such as stringent testing protocols and regular audits, to detect and mitigate potential issues early. The collaboration between different teams within a pharmaceutical company, including scientists, engineers, and quality assurance professionals, is crucial for sustaining quality throughout the product lifecycle. Moreover, the article addresses the necessity of adhering to global standards and guidelines, such as Good Manufacturing Practices (GMP), to ensure consistency and reliability in drug production. By fostering a culture of continuous improvement and vigilance, pharmaceutical companies can effectively safeguard public health and maintain trust in their products. This holistic approach underscores that delivering quality medicine is an ongoing commitment requiring coordinated efforts across the entire organization.

Abstract: Educating healthcare workers (HCWs) to take action against monkeypox (mpox) is an important part of public health prevention efforts. The study aimed to assess the knowledge, attitudes, and willingness to vaccinate against mpox among HCWs in the Kurdistan Region of Iraq. This study utilized an online cross-sectional survey that was disseminated via Google Forms between November, 1, 2022 and January, 15, 2023, employing a convenience sampling method. The researchers utilized logistic regression to ascertain the factors associated with knowledge, attitude and willingness to vaccinate. A total of 637 HCWs were included in the analysis (ages ranged between 21 and 51 years old). The mean overall score and standard deviation of the knowledge, attitude, and willingness assessment on mpox were 8.18±3.37 out of (0–16), 3.40±1.37 out of (0–5), 2.41±1.25 out of (0–5), respectively. The multivariate logistic regression analysis showed that HCWs who heard about mpox before 2022 had a higher level of knowledge (AOR: 4.85; 95% CI: 2.81-8.36; p < 0.001). In addition, those who had less than 1 year of practice had a positive attitude about mpox (AOR: 0.35; 95% CI: 0.20-0.59; p < 0.01). Finally, none of the variable groups had the capacity to predict willingness to be vaccinated against mpox. The research revealed that HCWs exhibit a relatively low level of knowledge and attitude towards mpox, as well as a low level of willingness to receive mpox vaccinations. Further, there is an urgent need to increase their knowledge and attitude, as the success of efforts to control the global epidemic depends on them.

Background: Australia received its first case of coronavirus on 25 January 2020. Since then the demands of COVID-19 has presented unparalleled levels of strain on the public healthcare systems in the country. In this time of crisis, pharmacists and community pharmacy staff have modified work strategies according to the rapidly changing environment. With a delayed dissemination of resources and guidelines, pharmacist and pharmacies are practicing innovative infection control methods across Australia to protect their staff, patients and the community. This article seeks to explore the current activities undertaken by pharmacists in various community pharmacy settings across Australia in relation to the safety of the workplace environments for staff and patients. Information collected can help inform future decisions in pandemic preparation for pharmacies in response to similar health crisis now and in the future. Methods: An online cross-sectional survey study was conducted in Australia during the COVID-19 outbreak from 1^st to 30^th April 2020. The questionnaire addressed community pharmacist’s awareness and response to infection and sanitation control. Results: A total of 137 pharmacists took part in the survey, with almost half (45.26%) belonging to the age group of 25 to 34 years. Community pharmacy formed the bulk (89.05%) of the respondent’s primary place of practice. There was a good uptake of safety measures by pharmacists and their pharmacies to protect staff and patients. However the task of reassigning high health risk staff was not heavily practiced (34.31%). Regular cleaning took place in the pharmacy, but the use of gloves while cleaning was not practiced in 48.18% of respondents. In addition, only 46.72% of respondents reported observing script baskets being cleaned and disinfected. About one-third (37.96%) of pharmacists were aware of the two-step cleaning and disinfecting process, but only 18.98% of pharmacists reported observing or performing this sanitation procedure. More than half of surveyed pharmacists reported having difficulty keeping up with infection control changes and pharmacy practice guidelines during the pandemic. Conclusion: This study demonstrates that the majority of pharmacists are not fully aware of the infection control measures needed in a community pharmacy setting. The influx of coronavirus updates has made it difficult for pharmacists to implement accurate procedures on some aspects of workplace hygiene, which may have led to some gaps in infection control measures. Pharmacists must aim to uphold their public health ambassador role and aim to keep up-to-date with professional guidance to provide the necessary infection control measures to ensure staff, patient and public health safety.

The effective dissemination and implementation of health service interventions into practice requires a range of strategic and systematic approaches. This paper applies a conceptual implementation framework to the evaluation of a hospital-wide clinical pharmacy initiative, a redesign of the discharge medication prescription pathway. The influencing factors and strategies used to overcome potential negative influences are described and assessed.

Background: Pharmacists need up-to-date knowledge and decision-making support in HIV care. We aim to develop MARVIN-Pharma, an adapted artificial intelligence-based chatbot initially for people with HIV, to assist pharmacists, considering evidence-based needs. Methods: From Dec 2022 to Dec 2023, an online needs-assessment survey evaluated Québec pharmacists' knowledge, attitudes, involvement, and barriers relative to HIV care, alongside perceptions relevant to the usability of MARVIN-Pharma. Recruitment involved convenience and snowball sampling, targeting National HIV and Hepatitis Mentoring Program affiliates. Results: Forty-one pharmacists (28 community, 13 hospital-based) across 15 Québec municipalities participated. Participants perceived their HIV knowledge as moderate (M=3.74/6). They held largely favorable attitudes towards providing HIV care (M=4.02/6). They reported a “little” involvement in the delivery of HIV care services (M=2.08/5), most often ART adherence counseling, refilling, and monitoring. The most common barriers reported to HIV care delivery were a lack of time, staff resources, clinical tools, and HIV information/training, with pharmacists at least somewhat agreeing that they experienced each (M≥4.00/6). On average, MARVIN-Pharma's acceptability and compatibility were in the ‘undecided’ range (M=4.34, M=4.13/7, respectively), while pharmacists agreed to their self-efficacy to use online health services (M=5.6/7). Conclusion: MARVIN-Pharma might help address pharmacists' knowledge gaps and barriers to HIV treatment and care, but pharmacist engagement in the chatbot’s development seems vital for its future uptake and usability.