Ali Mawfek Khaled Hindi

Background: Glucagon-like peptide-1 receptor agonists are increasingly prescribed for weight loss, but concerns remain regarding adverse events beyond gastrointestinal, renal, and pancreatic effects. Understanding these risks is essential to guide safe clinical application and public health policy. The study aims to characterize psychiatric risks, administration-related adverse events, and patterns of inappropriate use associated with semaglutide, liraglutide, and tirzepatide for weight management. Methods: Disproportionality analysis using proportional reporting ratios and reporting odds ratios was conducted to detect significant signals in adverse event reports within the U.S. Food and Drug Administration Adverse Event Reporting System, identifying semaglutide, liraglutide, or tirzepatide as drugs used for weight loss while excluding gastrointestinal, renal, and pancreatic adverse events. Results: Among 40,253 adverse event reports (68.6% female; median ages: semaglutide, 62 years; liraglutide, 59 years; tirzepatide, 53 years), semaglutide demonstrated the strongest disproportionality signal for psychiatric adverse events, notably anxiety (PRR 1.34, 95% CI 1.18–1.51), depression (PRR 1.83, 95% CI 1.62–2.07), and suicidal ideation (PRR 3.44, 95% CI 2.98–3.97). Tirzepatide showed markedly higher signals for injection-site reactions (PRR 7.98, 95% CI 7.8–8.18) and inappropriate use, including incorrect dosing and off-label administration (PRR 5.98, 95% CI 5.9–6.06). Conclusions: In real-world use, semaglutide is disproportionately associated with psychiatric adverse events, whereas tirzepatide demonstrates higher rates of injection-site complications and misuse. Liraglutide presents a comparatively lower risk profile. These findings underscore the need for vigilant psychiatric monitoring, patient education on injection technique and dosing, and stronger regulatory oversight to reduce misuse of GLP-1 receptor agonists for weight loss.

Objectives: to assess the safety profile of Gastrointestinal (GIT), renal, and pancreatic effects of GLP-1 and dual receptor agonists. Methods: Disproportionality analyses were performed on FDA Adverse Event Reporting System (FAERS) data following each drug’s approval for weight management. Signals were identified using Proportional Reporting Ratio (PRR) and Reporting Odds Ratio (ROR) with 95% confidence intervals (CIs). Results: Among GIT AEs, semaglutide (n = 12,321; 1.65%) showed the strongest signals (PRR 3.97, ROR 14.21), exceeding liraglutide (n = 5972, 0.45%, PRR 2.76, ROR 5.01) and tirzepatide (n = 4056, 3.48%, PRR 1.64, ROR 1.90). For renal and pancreatic outcomes, liraglutide demonstrated the highest overall signal (PRR 4.91, ROR 5.35), particularly for acute pancreatitis (PRR 18.9, ROR 19.4) and pancreatic carcinoma (PRR 18.6, ROR 19.5). Semaglutide showed stronger associations with diabetic ketoacidosis (DKA) (PRR 5.86, ROR 5.9) and acute kidney injury (AKI) (PRR 1.25, ROR 1.25). Tirzepatide demonstrated weaker or absent signals across most outcomes. Conclusions: This study revealed that semaglutide was most associated with GIT events, while liraglutide showed stronger renal and pancreatic signals. Novel associations with DKA and AKI were observed, warranting clinical vigilance. Findings should be cautiously interpreted given surveillance limitations, emphasising the need for large-scale real-world studies to confirm safety profiles.

Background: Declining continuity of care in England could disproportionately affect some patient groups. Aim: To examine patients’ perceptions of continuity of primary care, identify factors associated with continuity, and measure changes in continuity of care for different patient groups, following primary care network (PCN) implementations. Design & setting: Cross-sectional surveys were undertaken of patients from three groups (older adults with polypharmacy, patients with mild or moderate anxiety or depression, and working-age adults [18–45 years]), attending 19 practices in five PCNs in England, at two timepoints (November 2021–April 2022 and November 2022–April 2023). Method: Relational continuity was measured using the Nijmegen Continuity Questionnaire (NCQ) score. Differences between patient groups and two timepoints were tested using multiple linear regression. Results: Survey response rates were n = 362/1547 (23%) and n = 350/1528 (23%). Adults with polypharmacy experienced significantly better continuity than adults with anxiety or depression and younger working-age adults after adjusting for PCN, practice, and population-level characteristics ( P < 0.05). Those who always or sometimes saw their preferred GP experienced significantly better continuity than those who never did ( P < 0.01). PCNs with pre-existing inter-practice collaborations were not associated with differences in relational continuity. Conclusion: We found differences in experienced continuity of care between patient groups. Relational continuity depends on seeing a preferred GP, not a non-preferred GP or other healthcare professional (HCP). Better continuity was associated with larger practice networks.

Healthcare systems globally are expanding community pharmacy services to meet patient needs and reduce healthcare costs. In England this includes helping community pharmacies to provide integrated professional services but concerns persist over quality of care. This study aimed to identify priorities from key stakeholders for improving the quality of professional community pharmacy services. Six homogenous nominal group (NG) discussions (face-to-face and online) involved 36 participants from diverse stakeholder backgrounds. Participants included patients (n = 10), community pharmacists (n = 7), general practitioners, a general practice-based pharmacist (n = 4), community pharmacy service regulators (n = 5), Community Pharmacy England members (n = 4), and Local Pharmaceutical Committee members (n = 6), both responsible for negotiating services. Delbecq’s NG technique included silent idea generation, round-robin feedback, discussion, and ranking for consensus building. Discussions were audio-recorded and verbatim transcripts analysed thematically using NVivo12. Emerging themes across all NGDs were analysed by thematic analyses. Individual discrete ranking within each NGD were then combined by summing the mean scores of the categories within each theme. Five key themes emerged from qualitative analysis across all NGDs: quality service design, sustained funding, integration with the wider healthcare system, positioning community pharmacy as a hub for patient needs, and adequate workforce training, optimising staffing and retention. Participants emphasised the need for long-term commitment to quality service design centred on addressing local patient need, sustained and predictable funding. Community pharmacy staff having some access to patient records for making informed clinical decisions was discussed. Scoring priorities ranked as follows (highest to lowest): ensuring quality service design, sustained funding, integration with healthcare systems, community pharmacy as patient hubs, and workforce training and retention, reflecting different stakeholder priorities in these areas. This study highlighted core priority areas for a framework to improve the quality of community pharmacy professional services within a more responsive and integrated primary care led healthcare system.

Objective To identify the defining features of the quality of community pharmacy (CP) services and synthesise these into an evidence-based quality framework. Design Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources International research evidence (2005 onwards) identified from six electronic databases (Embase, PubMed, Scopus, CINAHL, Web of Science and PsycINFO) was reviewed systematically from October 2022 to January 2023. Search terms related to ‘community pharmacy’ and ‘quality’. Eligibility criteria for selecting studies Titles and abstracts were screened against inclusion or exclusion criteria, followed by full-text screening by at least two authors. Qualitative, quantitative and mixed-method studies relevant to quality in CP were included. Data extraction and synthesis A narrative synthesis was undertaken. Following narrative synthesis, a patient and public involvement event was held to further refine the quality framework. Results Following the title and abstract screening of 11 493 papers, a total of 81 studies (qualitative and quantitative) were included. Of the 81 included studies, 43 investigated quality dimensions and/or factors influencing CP service quality; 21 studies assessed patient satisfaction with and/or preferences for CP, and 17 studies reported the development and assessment of quality indicators, standards and guidelines for CPs, which can help define quality. The quality framework emerging from the global literature consisted of six dimensions: person-centred care, access, environment, safety, competence and integration within local healthcare systems. Quality was defined as having timely and physical access to personalised care in a suitable environment that is safe and effective, with staff competent in the dispensing process and pharmacy professionals possessing clinical knowledge and diagnostic skills to assess and advise patients relative to pharmacists’ increasingly clinical roles. Conclusion The emerging framework could be used to measure and improve the quality of CP services. Further research and feasibility testing are needed to validate the framework according to the local healthcare context.

Worldwide, hospital-acquired infections (HAIs) are continuously rising within healthcare settings, leading to high mortality and morbidity rates. Many hospitals have reported the spread of carbapenemases globally, specifically within the E. coli and K. pneumoniae species. This study was aimed at analyzing the state of hospital-acquired, carbapenem-resistant E. coli and K. pneumoniae in the United Kingdom between 2009 and 2021. Moreover, the study analyzed the most efficacious approaches to patient management for controlling the carbapenem-resistant Enterobacteriaceae (CRE) spread. Initially, 1094 articles were identified as relevant for screening, and among them, 49 papers were eligible for full-text screening, with a total of 14 articles meeting the inclusion criteria. The information was recorded from published articles through PubMed, the Web of Science, Scopus, Science Direct, and the Cochrane library and was used to search for hospital-acquired carbapenem-resistant E. coli and K pneumoniae in the UK between 2009 and 2021, in order to evaluate the spread of CRE in hospitals. The total number of carbapenem-resistant E. coli was 1083 and this was 2053 for carbapenem-resistant K. pneumoniae in more than 63 UK hospitals. KPC was the dominant carbapenemase produced by K. pneumoniae. The results showed that the treatment options considered depended on the type of carbapenemase produced; K. pneumoniae showed more resistance to a treatment options, i.e., Colistin, than the other carbapenemase. The current state of the UK is at minimal risk for a CRE outbreak; however, appropriate treatment and infection control measures are highly required to prevent this CRE spread at the regional and global levels. The present study findings have an important message for physicians, healthcare workers, and policymakers about hospital-acquired carbapenem-resistant E. coli and K. pneumoniae spread and approaches to patient management.

Objective To apply educational theory to explore how supervision can contribute to the development of advanced practitioners using the example of several postregistration primary care training pathways for pharmacy professionals (pharmacists and pharmacy technicians). Design Qualitative semistructured telephone interviews applying Billet’s theory of workplace pedagogy for interpretation. Setting England. Participants Fifty-one learners and ten supervisors. Primary outcome Contribution of clinical and educational supervision to the development of advanced practitioners in primary care. Results Findings were mapped against the components of Billet’s theory to provide insights into the role of supervision in developing advanced practitioners. Key elements for effective supervision included supporting learners to identify their learning needs (educational supervision), guiding learners in everyday work activities (clinical supervision), and combination of regular prearranged face-to-face meetings and ad hoc contact when needed (clinical supervision), along with ongoing support as learners progressed through a learning pathway (educational supervision). Clinical supervisors supported learners in developing proficiency and confidence in translating and applying the knowledge and skills they were gaining into practice. Learners benefited from having clinical supervisors in the workplace with good understanding and experience of working in the setting, as well as receiving clinical supervision from different types of healthcare professionals. Educational supervisors supported learners to identify their learning needs and the requirements of the learning pathway, and then as an ongoing available source of support as they progressed through a pathway. Educational supervisors also filled in some of the gaps where there was a lack of local clinical supervision and in settings like community pharmacy where pharmacist learners did not have access to any clinical supervision. Conclusions This study drew out important elements which contributed to effective supervision of pharmacy advanced practitioners. Findings can inform the education and training of advanced practitioners from different professions to support healthcare workforce development in different healthcare settings.

The Pharmacy Integration Fund commissioned 95 cross‐sector pre‐registration trainee pharmacist placements across England, which incorporated trainees spending 3–6 months in general practice (GP), whilst employed in hospital or community pharmacy. Delivery models varied (blocks or split weeks/days); trainees had pharmacist tutors at the employing/base (hospital/community pharmacy) organisation and in GP. This study aimed to evaluate implementation of cross‐sector pre‐registration placements, and to identify barriers and enablers of a “successful” placement that achieved its intended outcomes. A qualitative study was undertaken, using semi‐structured interviews with triads/dyads of trainee and pharmacist tutors at base and/or GP site. Interviews explored trainees’ and tutors’ GP placement experiences, and the contribution of GP placements to achieving intended learning outcomes. Data were thematically analysed. Thirty‐four interviews (14 trainees, 11 base tutors, 9 GP tutors) were completed in 11 study sites (5 GP/hospital; 6 GP/community pharmacy). GP placements were perceived as valuable and producing well‐rounded pre‐registration trainees with a good understanding of two settings. Key benefits of GP placements were trainees’ ability to work within multidisciplinary teams, and improved clinical and consultation skills. Contingency planning/flexibility was important when setting up cross‐sector placements. GP tutor supervision which supported a gradual transition from shadowing to more independent clinical practice with feedback was perceived as valuable. Good collaboration between tutors at the base and GP site ensured joined‐up learning across settings. All participants considered 13 weeks in GP an appropriate minimum duration; community trainees preferred longer duration (26 weeks) for more opportunities for clinical and consultation skills learning. Base and GP tutors would welcome clarity on which pre‐registration competencies should be achieved in GP placements, which would also aid quality and consistency across providers. Findings from this study identified key attributes of a successful pre‐registration cross‐sector training experience. These findings can inform policy reforms including changes to initial education and training of pharmacists.

Currently, there is little experiential learning in general practice (GP) during UK undergraduate and postgraduate pharmacy education and training. To apply educational theories to explore pharmacy stakeholders’ perceptions of placements in general practice and contribute to the development of a model of experiential learning for pharmacy. Qualitative, semi-structured interviews, conducted as part of two studies exploring experiential learning in general practice, with learners and their GP based supervisors. Interviews explored experiences of learning and practice, and what aided or hindered this. An abductive approach to analysis combined inductive coding with deductive, theory-driven interpretation using Lave and Wenger’s concept of “Communities of Practice”. Forty-four interviews were conducted, with learners and placement supervisors. Participants valued placements for providing authentic patient-facing learning experiences in the workplace, facilitated through legitimate peripheral participation by supervisors and supported by the use of pre- and de-briefing. Learners benefitted from support from their supervisor(s) and other staff during their day-to-day learning (informal learning), whilst also having protected time with their supervisors to discuss learning needs or go through workplace-based assessments (formal learning). Lack of clarity regarding which and how competencies should be assessed / demonstrated in general practice challenged monitoring progress from peripheral to full participation. Findings suggest that GP placements provide opportunities for learning about the patient journey between care settings; to work effectively with multidisciplinary teams; and consolidation and application of consultation / communication skills learning. The learning culture of GP supports learners’ development, providing time and opportunities for meaningful and authentic workplace learning, with healthcare professionals acting as supervisors and mentors. These findings can usefully inform implementation of meaningful learning opportunities in primary and secondary care for those involved in pharmacy education and training.