UNASSIGNED: In recent decades, there has been an interest in clinical pharmacy practice in Türkiye with emerging studies in this area. Despite the recent emergence of diverse pharmacy practice studies in Türkiye, a comprehensive assessment of overall typology of studies and impact has not been conducted thus far.
UNASSIGNED: This systematic review aims to document and assess pharmaceutical policy and practice literature published within the last 5 years in Türkiye. The other aim is to summarise the expected impact of published studies on policy and practice research.
UNASSIGNED: The systematic review was conducted according to the guidelines described in the PRISMA Statement. A comprehensive search approach, incorporating Medical Subject Headings (MeSH) queries and free-text terms was employed to locate pertinent literature related to pharmacy practice and policy in Türkiye. The search covered the period from January 1, 2019, to January 1, 2024, and involved electronic databases including PubMed, Medline Ovid, Scopus, ScienceDirect, Springer Link, PlosOne, and BMC.
UNASSIGNED: In the final grouping, 73 articles met the inclusion criteria and were selected for this review. Among the quantitative studies, majority studies were cross-sectional survey studies. Through the rigorous thematic content analysis seven research domains were developed from the selected literature: drug utilisation and rational drug use, the emerging role of pharmacist, access to medicines and generic medicines, community pharmacy practice, pharmacovigilance/adverse drug reactions, and pharmacoeconomic studies.
UNASSIGNED: The pharmacist role is evolving; however, several challenges remain in fully realising the potential of pharmacists. These include regulatory barriers, limited public awareness of pharmacists\' expanded roles, workforce capacity issues, and the need for ongoing professional development and training. Research studies are needed in the areas of generic prescribing, medicine adherence, intervention studies in community and hospital pharmacy practice, and on pharmacoeconomics and pharmacovigilance.

This review aimed to assess the quality and nature of the literature related to digital simulation-based pharmacology education. Specifically, we sought to understand the influence of simulations on the knowledge, satisfaction, and confidence of pre-registration nurses and other healthcare students participating in such educational programs.
Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. This study was registered in the Prospective Register of Systematic Reviews (PROSPERO, reg no: CRD42023437570).
PubMed, MEDLINE, APA PsycInfo, ProQuest, Web of Science, ScienceDirect, and CINHAL databases were searched.
The review focused on the quantitative findings from the studies published from 2016 to 2023. Only the studies that assessed the impact of digital simulation-based pharmacology education on pre-registration healthcare students\' knowledge, satisfaction, and confidence were selected for review. Data were synthesized using a narrative approach. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the included articles. This was followed by a narrative synthesis to consolidate the themes.
Out of 1587 articles,16 met the inclusion criteria. A wide variety of digital technologies have been utilised, such as virtual simulation, computer simulation (2D/3D), mixed reality, and augmented reality, with the majority using virtual simulation. All studies implemented single-user simulations. The themes emerging from the narrative synthesis suggest that a digital simulation-based pharmacology course is an effective tool for enhancing students\' knowledge, confidence, and satisfaction in learning pharmacological concepts. Furthermore, simulation-based teaching with a blended approach was found to be beneficial. However, the integration of the polypharmacy concept and the intra and interprofessional approach to teaching and learning was not evident in these studies.
This systematic literature review provides evidence of the potential of digital simulation-based education in pharmacology teaching among healthcare pre-registration students. In future studies, the integration of polypharmacy content with an intra and interprofessional teaching-learning approach is recommended.

OBJECTIVE: This study aims to explore dentists\' knowledge, attitudes, and perceptions regarding antibiotic use.
METHODS: We conducted a systematic review of dentists\' knowledge, attitudes and perceptions regarding antibiotic use, by searching the MEDLINE, EMBASE and Web of Science for all original paper published from January 1990 to July 2023, in accordance with the Preferred Reporting Items for systematic Reviews and Meta-analyses (PRISMA 2020) guidelines.
RESULTS: The review included 37 papers, (7 qualitative and 30 quantitative studies). Modifiable factors (knowledge, attitudes) were reported as being associated with antibiotic prescribing by dentists which were cited in 30 of the 37. These attitudes most frequently identified by dentists were: complacency (22/29); lack of trust (16/29); the need to postpone the dental procedure (17/29); and fear (8/29). Gaps in knowledge were also identified (15/29). Only one of the included articles quantified the influence between the reported modifiable factors and antibiotic prescribing.
CONCLUSIONS: The review emphasizes that dentists\' antibiotic prescribing is predominantly influenced by modifiable factors. This insight informs the potential for targeted interventions to curtail inappropriate antibiotic use, contributing to global efforts in reducing antibiotic resistance. The protocol of this systematic review can be found in PROSPERO under registration no. CRD42021253937.

Opioid prescribing and dispensing from emergency departments is a noteworthy issue given widespread opioid misuse and diversion in many countries, contributing both physical and economic harm to the population. High patient numbers and the stochastic nature of acute emergency presentations to emergency departments (EDs) introduce challenges for prescribers who are considering opioid stewardship principles. This study investigated the effect of changes to electronic prescribing software on prescriptions with an auto-populated quantity of oxycodone immediate release (IR) from an Australian tertiary emergency department following the implementation of national recommendations for reduced pack sizes. A retrospective review of oxycodone IR prescriptions over two six-month periods between 2019 and 2021 was undertaken, either side of a software adjustment to reduce the default quantities of tablets prescribed from 20 to 10. Patient demographic details were collected, and prescriber years of practice calculated for inclusion in linear mixed effects regression modelling. A reduction in the median number of tablets prescribed per prescription following the software changes (13.5 to 10.0, p < 0.001) with little change in the underlying characteristics of the patient or prescriber populations was observed, as well as an 11.65% reduction in the total number of tablets prescribed. The prescriber\'s years of practice, patient age and patient sex were found to influence increased prescription sizes. Reduced quantity of oxycodone tablets prescribed was achieved by alteration of prescribing software prefill parameters, providing further evidence to support systems-based policy interventions to influence health care providers behaviour and to act as a forcing function for prescribers to consider opioid stewardship principles.

OBJECTIVE: Since assessment of prescribing competence is a key promoter of student learning and achievement, we aim to summarize existing national-level approaches, provide a systematic review of current literature, indicate the frequency of various methodologies, and make recommendations to promote and extend existing practice.
METHODS: Regulatory body websites were accessed for details of national examinations. PubMed, Embase, the Allied and Complementary Medicine, and CINAHL databases were systematically searched in August 2023 for studies in English from Europe, North America, Australia and New Zealand reporting assessment of prescribing competencies among students/practitioners. Additional articles were identified through citation tracking.
RESULTS: National approaches are described for several jurisdictions. A total of 20 514 articles were retrieved, of which 54 met the inclusion criteria. Most articles came from the UK, with medical students and qualified doctors most frequently featured. Multiple choice formats were most common, with short answer questions, calculations and scenario-based skills tests also featured. Direct observations of skills through Objective Structured Clinical Examinations and similar methods were less commonly described. Test reliability generally employed Classical Test Theory. Costs of developing and delivering assessments, differential attainment by demographics, and predictive validity were not indicated.
CONCLUSIONS: We recommend measurement of the predictive validity of prescribing competence assessments, the routine inclusion of performance by demographic characteristics, extension of competence assessments to professions other than medicine, and structured reporting of methods and findings, including costs and cost-effectiveness. Situational judgement tests would be a valuable addition to assessment practices.

BACKGROUND: Historically IV and enteral fluids given during acute kidney injury (AKI) were restricted before the introduction of continuous renal replacement therapies (CRRTs) when more liberal fluids improved nutrition for the critically ill. However, fluid accumulation can occur when higher volumes each day are not considered in the fluid balance prescribing and the NET ultrafiltration (NUF) volume target.
CONCLUSIONS: The delivered hours of CRRT each day are vital for achievement of fluid balance and time off therapy makes the task more challenging. Clinicians inexperienced with CRRT make this aspect of AKI management a focus of rounding with senior oversight, clear communication, and \"precision\" a clinical target. Sepsis-associated AKI can be a complex patient where resuscitation and admission days are with a positive fluid load and replacement mind set. Subsequent days in ICU requires fluid regulation, removal, with a comprehensive multilayered assessment before prescribing the daily fluid balance target and the required hourly NET plasma water removal rate (NUF rate). Future machines may include advanced software, new alarms - display metrics, messages and association with machine learning and \"AKI models\" for setting, monitoring, and guaranteeing fluid removal. This could also link to current hardware such as on-line blood volume assessment with continuous haematocrit measurement.
CONCLUSIONS: Fluid balance in the acutely ill is a challenge where forecasting and prediction are necessary. NUF rate and volume each hour should be tracked and adjusted to achieve the daily target. This requires human and machine connections.

OBJECTIVE: Despite 10 years of prescribing scheduled medicines by Endorsed Midwives, little is known about prescribing practices.
BACKGROUND: Endorsed Midwives can prescribe scheduled medicines and have access to Medicare rebates to support service provision. Endorsed Midwives have the potential to improve access to medications for women, however, are met with barriers, including inconsistencies in state and national legislation.
OBJECTIVE: To search for what is published regarding Endorsed Midwife prescribing of scheduled medicines in Australia, report on the literature, synthesise the findings and discuss the results.
METHODS: A scoping review utilising the Joanna Brigg\'s Institute methodology. A search of CINAHL, PubMed, Science Direct and Medline databases was conducted. Seven peer-reviewed articles were identified; three discussion papers, one literature review and three research papers, published between 2016 and 2023 in English. Qualitative content analysis was used to identify topic areas.
RESULTS: Four topic areas were identified: 1) Endorsed Midwives increase women\'s access to prescribed medications; 2) the Pharmaceutical Benefits Scheme is restrictive and diminishes midwifery prescribing; 3) medication prescribing depends on internal and external structures; 4) professional relationships support prescribing.
CONCLUSIONS: The authority to prescribe augments Endorsed Midwives\' practice, improves timely access to medications and enhances role satisfaction. The effective use of midwifery prescribing is hampered by barriers such as the Pharmaceutical Benefits Scheme, inappropriate medication formularies, and poorly designed health service policy.
CONCLUSIONS: To fully utilise Endorsed Midwife prescribing in all settings of maternity care, further work is required to develop education, remove barriers, and demonstrate the safety and effectiveness of midwifery prescribing.

OBJECTIVE: Considerable efforts have been made to improve guideline adherence in healthcare through de-implementation, such as decreasing the prescription of inappropriate medicines. However, we have limited knowledge about the effectiveness, barriers, facilitators and consequences of de-implementation strategies targeting inappropriate medication prescribing in secondary care settings. This review was conducted to understand these factors to contribute to better replication and optimisation of future de-implementation efforts to reduce low-value care.
METHODS: A systematic review of randomised control trials was conducted. Papers were identified through CINAHL, EMBASE, MEDLINE and Cochrane register of controlled trials to February 2021. Eligible studies were randomised control trials evaluating behavioural strategies to de-implement inappropriate prescribing in secondary healthcare. Risk of bias was assessed using the Cochrane Risk of Bias tool. Intervention characteristics, effectiveness, barriers, facilitators and consequences were identified in the study text and tabulated.
RESULTS: Eleven studies were included, of which seven were reported as effectively de-implementing low-value prescribing. Included studies were judged to be mainly at low to moderate risk for selection biases and generally high risk for performance and reporting biases. The majority of these strategies were clinical decision support at the \'point of care\'. Clinical decision support tools were the most common and effective. They were found to be a low-cost and simple strategy. However, barriers such as clinician\'s reluctance to accept recommendations, or the clinical setting were potential barriers to their success. Educational strategies were the second most reported intervention type however the utility of educational strategies for de-implementation remains varied. Multiple barriers and facilitators relating to the environmental context, resources and knowledge were identified across studies as potentially influencing de-implementation. Various consequences were identified; however, few measured the impact of de-implementation on usual appropriate practice.
CONCLUSIONS: This review offers insight into the intervention strategies, potential barriers, facilitators and consequences that may affect the de-implementation of low-value prescribing in secondary care. Identification of these key features helps understand how and why these strategies are effective and the wider (desirable or undesirable) impact of de-implementation. These findings can contribute to the successful replication or optimisation of strategies used to de-implement low-value prescribing practices in future.
BACKGROUND: The review protocol was registered at PROSPERO (ID: CRD42021243944).

The aim of this umbrella review was to identify tools and guidelines to aid the deprescribing process of potentially inappropriate medications (PIMs), evaluate development and validation methods, and describe evidence levels for medication inclusion.
Searches were conducted on MEDLINE (Ovid), Embase.com, Cochrane CDSR, CINAHL (EBSCO), Web of Science Core Collection and guideline databases from the date of inception to 7 July 2022. Following the initial search, an additional search was conducted to identify an updated versions of tools on 17 July 2023. We analysed the contents of tools and guidelines.
From 23 systematic reviews and guidelines, we identified 95 tools (72 explicit, 12 mixed and 11 implicit) and nine guidelines. Most tools (83.2%) were developed to use for older persons, including 14 for those with limited life expectancy. Seven tools were for children <18 years (7.37%). Most explicit/mixed tools (78.57%) and all guidelines were validated. We found 484 PIMs and 202 medications with different appropriateness independent of disease for older persons with normal and limited life expectancy, respectively. Only two tools and eight guidelines reported the evidence level, and a quarter of medications had high-quality evidence.
Tools are available for a diversity of populations. There were discrepancies, with the same medication being classified as inappropriate in some tools and appropriate in others, possibly due to low-quality evidence. In particular, tools for patients with limited life expectancy were developed based on very limited evidence, and research to generate this evidence is urgently needed. Our medication lists, along with the level of evidence, could facilitate efforts to strengthen the evidence.

BACKGROUND: The role of nurse prescribers is developing rapidly to meet rising health care demands worldwide. However, prescribing is a complex process that requires nurses to receive the proper education.
OBJECTIVE: To identify what is known in the research field on nurse prescribing education.
METHODS: Arksey and O\'Malley\'s five-stage methodological framework was used to guide this scoping review.
METHODS: PubMed, Web of Science, CINAHL, Embase, and the Cochrane Library.
METHODS: Databases were searched from inception to December 31, 2022. Data were extracted from papers meeting the inclusion criteria using the data chart and synthesized using a narrative method.
RESULTS: Seventy-one studies were included in the scoping review. Five education content themes and four education modes were identified. In addition, positive effects of nurse prescribing education and the learning needs of nurses were also found.
CONCLUSIONS: There is considerable heterogeneity in nurse prescribing education content and mode. This scoping review highlights the benefits of implementing education programs to prepare nurses for prescribing. However, nurses still have some unmet needs for prescribing education. More longitudinal studies and evaluation tools are needed to determine long-term effects. Future nurse prescribing education programs could consider the dual mentorship system, interactive educational activities, and specialized courses to improve the motivation of nurses and the quality of education.