Hospital Pharmacy

Burnout, recognized by the World Health Organization as a medical condition, has been linked to decreased productivity, disengagement, and hopelessness among employees. While burnout in frontline staff has received increasing attention, the unique challenges of leadership burnout remain underexplored and often underdiscussed.

According to the Development Dimensions International’s Global Leadership Forecast, nearly 60% of leaders reported feeling “used up” at the end of the workday. Yet, stigma and shame often prevent leaders from acknowledging burnout openly. Recent initiatives have provided resources to help leaders recognize and mitigate burnout within their teams; however, the literature addressing burnout among leaders themselves is scarce. Understanding the institutional impact of leadership burnout is critical for cultivating a sustainable culture of well-being. Simply put: leaders must be well in order to lead well.

Leaders play a vital role in recognizing, measuring, and addressing burnout risk factors across their organizations. However, unaddressed burnout at the leadership level can amplify organizational dysfunction and jeopardize long-term success. By acknowledging these risks and prioritizing their own well-being—putting their oxygen mask on first—leaders can better navigate uncertainty, safeguard their teams, and strengthen the resilience of the healthcare workforce.

The purpose of this article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature.

A group of board-certified nutrition support pharmacists compiled a list of articles relevant to pharmacy nutrition support that were published in 2025. Citations were organized into a spreadsheet, and each author independently assessed whether the article was important to nutrition support pharmacy practice. Articles receiving affirmative votes from at least 5 of the 8 participating authors were included in the final list of key publications. Guidelines, consensus statements, and recommendation papers considered important to practice were included, but not formally ranked.

A total of 124 articles were identified; 5 from the primary literature were voted by the group as being of high importance. Nine guidelines, position, recommendation, or consensus papers were also identified. The top-ranked articles from the primary literature were summarized and a narrative regarding its implications to pharmacy nutrition support practice were provided.

Pharmacists engaged in nutrition support therapy should be familiar with these publications, as they may have important implications for clinical practice.

Patients with end stage renal disease undergoing haemodialysis commonly have multimorbidity, which in turn leads to polypharmacy. Additionally, end stage renal disease limits the choice and dosage of medicines. In Namibia, patients can access care at privately run dialysis centres. Patients seen at state-run health facilities in need of renal care from the dialysis centres, have their renal care costs covered by the Ministry of Health and Social Services.

The main purpose of this study was to assess the appropriateness of medication therapy among patients with end stage renal disease who underwent haemodialysis at two dialysis centres in Windhoek. Further, the study also compared prescribing patterns between state-funded and privately funded haemodialysis patients.

A retrospective, quantitative and analytic design involving the review of clinical records of patients attending haemodialysis at the two dialysis centres. The types of medicines prescribed were classified according to the Anatomical Therapeutic Chemical (ATC) classification. The Drug Prescribing in Renal Failure Handbook was used as a primary reference for assessing the appropriateness of renal dosage adjustment. The primary references used to check for the appropriateness of medication choice were the KDIGO Clinical Practice Guidelines. Other references were used as secondary sources.

A total of 147 patients’ clinical records were reviewed and included in this study. About one-third (33.3%) of patients had at least one or more inappropriately selected medicines. Most patients 82.0% (n = 121) had at least one or more inappropriately renally adjusted medicines. More privately funded patients were prescribed Vitamin D or its analogues (P < .001), phosphate binders (P < .001), antithrombotic agents (P < .001), lipid modifying agents (P < .001), and angiotensin receptor blockers (P < .001).

As anticipated, patients on haemodialysis were being managed with a relatively large number of medicines. Renal dosage adjustment could be improved to ensure patient safety. The differences in the prescribing of vital medicines such as phosphate binders, between state funded versus privately funded patients warrants further investigation.

Tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 receptor agonist (GLP-1 RA), has demonstrated significant efficacy in weight reduction and glycemic control in patients with type 2 diabetes and obesity. However, concerns have emerged regarding its potential association with ophthalmic adverse events, particularly non-arteritic anterior ischemic optic neuropathy (NAION).

This study aimed to investigate the possible link between tirzepatide and ischemic optic neuropathy (ION) through pharmacovigilance analysis of the FDA Adverse Event Reporting System (FAERS) and to complement these findings with an infodemiology assessment using Google Trends.

FAERS reports from January 2022 to June 2025 were analyzed using OpenVigil 2.1 to identify cases of ION with tirzepatide as the primary suspect drug. Disproportionality analyses were performed using the Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), and Relative Reporting Ratio (RRR), and Evans criteria were applied for causality assessment. In parallel, global search interest in tirzepatide was evaluated using Google Trends data from 2020 to 2025 to explore public awareness and its potential impact on reporting patterns.

A total of 28 ION cases were identified for tirzepatide. The event is rare but serious. Disproportionality analysis yielded significant signals (ROR: 2.599, 95% CI: 1.778; 3.799; PRR: 2.598 95% CI: 1.778; 3.797; RRR: 2.522, 95% CI: 1.726; 3.685; Chi-Squared: 24.692), with Evans criteria supporting a “probable” drug-event association. Google Trends demonstrated an exponential rise in global search interest for tirzepatide, particularly in Western countries with high prevalence of obesity and type 2 diabetes, reflecting increased accessibility and use.

The pharmacovigilance analysis suggests a potential association between tirzepatide and ION, warranting cautious clinical consideration and further investigation. The event is rare but serious. Integrating pharmacovigilance data with digital epidemiology may enhance early signal detection and risk management for rare but clinically significant adverse events such as NAION.

The study aimed to assess pharmacy professionals’ attitudes, perceptions, practices, and concerns about using ChatGPT in routine clinical duties in Pakistan.

A descriptive cross-sectional study was conducted from 1 September 2024 to 1 April 2025. A self-administered questionnaire was distributed among pharmacy professionals employed in hospitals, communities, academic institutes, industries and other healthcare settings. A convenience sampling technique was utilized to recruit 405 participants. Data was analyzed using IBM SPSS statistics version 30, employing descriptive and inferential statistics, including Spearman’s rank correlation, chi-square test, and binary logistic regression analysis.

Among 405 participants, the majority were male (210, 51.9%), 230 (56.8%) participants were aged between 23 and 33 years, 196 (48.4%) participants identified as single. Regarding pharmacy positions, 115 participants (28.4%) were hospital pharmacists, and the majority, 145 participants (35.8%), possessed professional experience ranging from 1 to 5 years. Furthermore, 271 participants (67.0%) reported familiarity with AI technology in pharmacy practice. Majority of participants (n = 228, 56.3%) demonstrated a positive attitude, while (n = 222, 54.8%) exhibited a positive perception, and (n = 232, 57.3%) reported good practice toward ChatGPT integration. Additionally, 56.0% (n = 227) of participants exhibited higher concerns regarding the integration of ChatGPT.

The study findings indicate that more than half of the pharmacists demonstrated positive attitudes, perceptions, and good practices regarding using ChatGPT in pharmacy practice. Key concerns about its use include ethical considerations, privacy issues, data accuracy, and potential for bias. This highlights the necessity for extensive instructional programs to encourage educated and responsible use of ChatGPT in pharmacy practice. Future research should investigate developing and implementing customized training programs and protocols to guarantee ChatGPT’s secure and efficient incorporation into pharmacy processes for enhanced patient care.

Doxorubicin, as part of the chemotherapy regimen for breast cancer, has long been associated with cardiotoxicity, primarily manifested by a reduction in left ventricular ejection fraction (LVEF). Early detection of cardiac dysfunction is essential to prevent the progression of heart failure and ensure patient safety. This study aimed to analyze trends in LVEF reduction, the incidence of cardiotoxicity, and associated risk factors in breast cancer patients receiving doxorubicin-based chemotherapy at Dr. Hasan Sadikin General Hospital, Bandung.

We conducted a retrospective cohort study of 130 patients and further reviewed the medical records. The LVEF values were obtained from echocardiographic assessments performed before and after each chemotherapy cycle. The Mann-Whitney U test and Wilcoxon Signed Rank test were used to assess LVEF trends, while bivariate analysis was applied to evaluate the association between clinical variables and cardiotoxicity.

The results showed a statistically significant reduction in LVEF beginning after the third chemotherapy cycle and continuing through the sixth (P < .05), with a median decline of approximately 4% to 5%. The incidence of cardiotoxicity was 4.62%, with an additional 3.85% of patients classified as having borderline low LVEF. The age factor (P = .047) and a history of hypertensive heart disease (HHD) (P = .034) showed a statistically significant association with the incidence of left ventricular dysfunction, but no factors showed a statistically significant association with the incidence of cardiotoxicity.

The early onset of LVEF reduction highlights the critical role of routine cardiac monitoring during chemotherapy as a preventive strategy against cardiotoxicity progression. Identification of risk factors such as older age and preexisting cardiovascular conditions is essential for risk stratification and the implementation of safer and individualized treatment approaches.

Typical strategies for obtaining medication lists may be suboptimal for incarcerated individuals due to unavailability of electronic transmission and verification methods, leading to potential delays and inaccuracies during care transitions. This study reviews disease states and medication lists at admission and discharge for incarcerated patients at a large academic medical center, hypothesizing that discrepancies in chronic disease diagnoses and medication lists exist during these care transitions.

A retrospective, single-cohort analysis from January 1, 2017 to December 31, 2020, evaluated medication lists in incarcerated adults. Medication lists and chronic disease states, as defined by the Charlson comorbidity index, were assessed at 2 critical care transitions: on admission and at discharge. Pre-specified co-morbidities were selected to identify discrepancies involving missing or duplicate medications.

Of 557 eligible patients, 417 (75%) had active prescriptions on admission, averaging 8 medications per patient. Diagnostic discrepancies were infrequent upon admission and at discharge (3.9%), with conditions more often noted for the first time at discharge. In reviewing 309 patients with pre-specified co-morbidities, 55% exhibited at least 1 medication discrepancy, with an average of 1.65 co-morbidities reviewed per patient.

The healthcare teams caring for incarcerated patients face unique challenges in medication management during hospital transitions. These medication lists are characterized by a high incidence of medication discrepancies despite a low incidence of diagnostic differences. To enhance care continuity and minimize risks, healthcare systems need to implement streamlined, standardized medication reconciliation processes and improve institutional policies to better support this vulnerable population.

The optimal timing of initiating direct oral anticoagulants (DOACs) after ischemic stroke in patients with atrial fibrillation (AF) remains uncertain. Early initiation may reduce recurrent stroke risk but raise concerns about hemorrhagic complications. This study aimed to evaluate the efficacy and safety of early versus later anticoagulation after ischemic stroke in AF.

We systematically searched PubMed, EMBASE, CENTRAL, and Scopus from inception to May 22, 2025, for randomized controlled trials (RCTs) comparing early (≤4 days) versus later (5-14 days) DOAC initiation post-stroke in AF. Primary outcomes were recurrent ischemic stroke, symptomatic intracerebral hemorrhage (sICH), and all-cause mortality. Data were pooled using MetaXL (version 5.3) with a random-effects model. Heterogeneity was assessed using the Chi-square test and I² statistic.

Five RCTs (n = 6810) were included. Early anticoagulation showed a non-significant reduction in recurrent ischemic stroke (OR 0.80, 95% CI: 0.59-1.09; I² = 1%) and no significant difference in sICH (OR 0.92, 95% CI: 0.45-1.85; I² = 0%) or all-cause mortality (OR 0.94, 95% CI: 0.78-1.14; I² = 0%). Across all outcomes, heterogeneity was low and findings were consistent.

Early initiation of DOACs after ischemic stroke in AF appears safe and may modestly reduce stroke recurrence without increasing hemorrhagic or mortality risk. These findings support individualized decision-making and suggest that early anticoagulation is a reasonable strategy in appropriately selected patients.