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BACKGROUND: Treating multiple myeloma is complex, and providing supportive care through an interdisciplinary approach is essential. AIM: To report and synthesize pharmacists' clinical activities and impact on the care of patients with multiple myeloma. METHOD: This was a scoping review that followed the PRISMA-ScR reporting recommendations. A search was conducted in PubMed, Embase, Web of Science, Scopus, and LILACS from the inception of the database until January 10th, 2024. Papers that reported pharmacists' clinical activities in the care of patients with multiple myeloma were included. Descriptive Elements of Pharmacist Intervention Characterization Tool (DEPICT) version 2 was used to characterize the pharmacists' clinical activities. The results are presented as a narrative and tabular synthesis. RESULTS: A total of 2885 records were identified, 10 of which met the inclusion criteria. Pharmacists' clinical activities related to 'direct patient care' (n = 8) and 'medication counseling, education, and training' (n = 7) were the most cited. Most were provided for patients (n = 8), by one-on-one contact (n = 9), and through face-to-face communication method (n = 8), with patient counseling being the main action taken by pharmacists (n = 7). Materials that supported pharmacists' actions were cited in five studies. Integrating pharmacists into interdisciplinary teams led to improved process, clinical, humanistic, and economic outcomes. CONCLUSION: This scoping review emphasizes pharmacists' clinical activities in improving the care of patients with multiple myeloma. There is a need to develop studies with patient-reported outcomes and comprehensive reporting of pharmacists' clinical activities to ensure reproducibility and effective implementation in clinical practice.

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BACKGROUND: Prescribing by pharmacists is an increasingly common practice worldwide. In Brazil regulation of this practice began in 2013, and the practice remains unexplored as a research topic. OBJECTIVE: We aimed to explore and gain insights into pharmacist prescribing practices in Brazil and assessing pharmacist's perceptions of their training and preparedness to prescribe medications. METHODS: A cross-sectional survey was conducted between October 2022 and March 2023 via convenience sampling. Data were collected using an online questionnaire covering sociodemographic issues, academic training, prescribing practices, and perceptions regarding the provision of pharmacist prescribing in ambulatory care. Exploratory descriptive analysis and Poisson regression were performed to estimate the associations between pharmacist characteristics and their practices in prescribing medicines. RESULTS: Among the 305 valid responses, 58.7% of the outpatient pharmacists stated that they had not prescribed any medication in the previous three years. Over-the-counter medication prescriptions were most common (42.0%). Only 4.6% of respondents had prescribed prescription-only medicines provided through collaborative agreement, with 2.6% reporting that they had adjusted doses, and 2.3% played a role in prescription renewal. Pharmacists living in Northeast regions tended to be more active prescribers (PR = 1.42; 95%CI 1.03-2.18), whereas those in primary healthcare (PR = 0.61; 95%CI 0.39-0.96) and self-declared Black pharmacists (PR = 0.30; 95%CI 0.10-0.97) prescribed less. Respondents strongly believed in the pharmacist's role as a prescriber, although they remained ambivalent regarding their responsibility for patient outcomes. Progress barriers include infrastructure gaps and strained relationships with physicians. CONCLUSIONS: This study suggests that pharmacists in Brazil predominantly prescribe over-the-counter medications, and variations in setting, region, and race can influence prescribing by pharmacist in ambulatory care.

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Access to drugs for rare diseases constitutes a challenge to healthcare systems, especially those with public funding. This study aimed to map and summarize the criteria used by HTA agencies in different healthcare systems to evaluate reimbursement recommendations for orphan drugs. A comprehensive literature search was performed on the databases PubMed, LILACS, Scopus, and Embase and the gray literature (Google Scholar and websites of HTA agencies). Publications addressing the criteria used by HTA agencies in countries with public healthcare systems when evaluating reimbursement recommendations for orphan drugs were included. This scoping review included 23 studies published between 2014 and 2023, mostly consisting of reviews of HTA reports, guidance documents, and original articles. The criteria were mapped from 19 countries and ranked within three models of healthcare systems (National Health System, National Health Insurance, and Social Health Insurance). All models shared concerns about unmet needs and disease nature. In addition, NHS countries (e.g., United Kingdom, Sweden, and Italy) prioritized innovation and system-level impact, while SHI countries (e.g., Germany, France, the Netherlands) usually valued budget impact and employed expedited evaluation processes. This review provides a comprehensive understanding of the general tendencies of each healthcare system model in establishing differentiated criteria to address the challenges posed by the limited evidence and investment in the field of rare diseases.

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BACKGROUND: The community of lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other identities (LGBTQIA+), comprising sexual and gender minorities, frequently encounters violence, discrimination, and numerous obstacles in accessing health care services. Pharmacists have the potential to significantly contribute to the health care provision for this community. OBJECTIVE: To assess pharmacists' perceptions regarding academic preparedness and health care provision for the LGBTQIA+ community in Brazil. METHODS: An online cross-sectional survey was conducted from August 2022 to February 2023, focusing on the academic training of pharmacists and the provision of health care to the LGBTQIA+ community in Brazil. Data collection was achieved through a 28-question online questionnaire, comprising both closed-ended questions, and Likert-type items. The study variables were subjected to an exploratory descriptive analysis. RESULTS: We received 261 complete and valid responses. A majority of pharmacists indicated that they provided health care to the LGBTQIA+ community (n = 161, 61.7%); however, they lacked formal education on LGBTQIA+ health care during their pharmacy program (n = 256, 98.1%). Most participants strongly agreed that pharmacists play a crucial role in promoting health care for this community (n = 213, 81.6%). However, only a small percentage felt confident in addressing issues related to the effectiveness and safety of hormone use for transgender patients (n = 38, 14.6%). Furthermore, less than a third believed that the health care provided by pharmacists should be differentiated for patients within and outside of the LGBTQIA+ community (n = 76, 29.1%). CONCLUSION: The results of this study underscore the necessity and significance of incorporating this topic both in pharmacy training and continuing education. This approach is crucial to enhance and bolster the clinical practice of pharmacists.

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BACKGROUND: Consolidated and reliable evidence regarding the effectiveness of pharmacist interventions for deprescribing benzodiazepines in older outpatients is lacking. AIM: This study evaluated and summarized the impact of pharmacist interventions on benzodiazepine deprescribing among older outpatients. METHOD: A literature search was conducted until August 2022 in PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials databases. The review included randomized controlled trials that assessed the impact of pharmacist interventions on deprescribing benzodiazepine in older outpatients. Two independent investigators conducted the study selection, data extraction, and risk of bias assessment. Meta-analyses were conducted using random-effect models in the RStudio software. RESULTS: A total of 893 records were identified. Five studies, including 3,879 patients, met the inclusion criteria and were included in the systematic review. All five studies used health education as an intervention strategy, and three also conducted medication reviews. There was no evidence of the pharmacist's authority to modify prescriptions during benzodiazepine deprescribing. One study was classified as having a low risk of bias, whereas the other had some concerns or a high risk of bias. Three studies were included in the meta-analysis and a significant impact of pharmacist interventions on benzodiazepines deprescribing rates in older outpatients was observed (RR = 2.75 [95%CI 1.29; 5.89]; p = 0.04; I2 = 69%; low certainty of evidence). CONCLUSION: Pharmacists may contribute to deprescribing benzodiazepines in older outpatients. Further studies are needed to increase the reliability of these findings. PROSPERO registration number: CRD42022358563.

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INTRODUCTION: The analysis of drugs with adverse effects on voice provides relevant data for the vocal clinic. It is essential that professionals involved in voice care are aligned on the topic of voice pharmacovigilance in order to understand adverse effects from safe and reliable sources. OBJECTIVES: To compare the voice adverse effects of self-reported medications by dysphonic individuals in different sources of information. METHODS: Descriptive and analytical study based on self-reported active ingredients by dysphonic individuals and their adverse effects on voice listed in Electronic Database of the National Health Surveillance Agency of Brazil (Anvisa). Adverse effects were comparatively analyzed between the Anvisa's Electronic Database and information from the Micromedex and UpToDate databases. Data were analyzed using descriptive and inferential statistics that compared the three sources researched in relation to the number of adverse effects and in relation to the occurrence of adverse effects to the voice. RESULTS: There was a statistically significant difference between the databases regarding the occurrence of adverse effects of cough, dyspnea, xerostomia, vomiting and hoarseness, with a higher occurrence in the UpToDate database. The UpToDate database showed a statistically significant difference in the amount of drug effects compared to the Anvisa database (P < 0.001, d = 0.744) and compared to the Micromedex database (P < 0.001, d = 0.598), and in the two cases the mean number of drug effects was higher for the UpToDate database. CONCLUSIONS: UpToDate proved to be the most suitable source to complement the data from the medication package inserts at the time of the speech-language pathology assessment. It is recommended that professionals from all countries involved in voice care seek additional evidence-based sources of information to gain access to accurate and up-to-date data on adverse effects of drugs on voice.

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The objective is to analyze the contribution of the pharmaceutical industry to the sustainability of the Brazilian Unified National Health System (SUS), based on the pressure for the incorporation of medicines. For this purpose, a descriptive study was conducted on requests for the incorporation of medicines sent to Commission for Incorporation of Technologies in the SUS (CONITEC) from 2012 to 2020. Characteristics such as technology indication, economic evaluation, financing component, public consultation, and CONITEC decision were analyzed. The results were compared according to the type of solicitor using statistical tests. 514 requests were analyzed, of which 438 related to incorporation. The pharmaceutical industry accounted for 37% of the requests and 33.5% of the incorporations. Differences were observed between the solicitors regarding the type of economic evaluation and incremental cost-utility ratio value, with half of the industry's demands above the threshold of 3 PIB per capita/QALY. The pharmaceutical industry obtained more contributions in public consultations of its requests and presented concentration of requests for antineoplastic and immunomodulatory agents and for anti-infectious, especially for hepatitis C and HIV. There was also a lower number of demands from the pharmaceutical industry in the Basic and Strategic Components of Pharmaceutical Assistance. Our findings point to the tension between the significant participation of the industry as an applicant, the high mobilization of public consultations, the emphasis on Specialized Component drugs, and CONITEC's resistance to this pressure, with a tendency of greater refusal and greater participation of other solicitors in requests for expansion of use, exclusion, and incorporation of drugs that are less requested by the pharmaceutical industry.

O objetivo foi analisar a contribuição da indústria farmacêutica na sustentabilidade do Sistema Único de Saúde (SUS), a partir da pressão pela incorporação de medicamentos. Para tanto, foi realizado estudo descritivo das solicitações de incorporação de medicamentos enviadas à Comissão Nacional de Incorporação de Tecnologias no SUS (CONITEC) entre 2012 e 2020. Foram analisadas características como a indicação da tecnologia, avaliação econômica, componente de financiamento, consulta pública e decisão da CONITEC. Os resultados foram comparados segundo o tipo de demandante por teste estatístico. Foram analisadas 514 solicitações, sendo 438 referentes à incorporação. A indústria farmacêutica foi responsável por 37% das solicitações e 33,5% das incorporações. Foram observadas diferenças entre os demandantes quanto ao tipo de avaliação econômica e ao valor de razão custo-utilidade incremental, com metade das demandas da indústria acima do limiar de 3 PIB per capita/QALY. A indústria farmacêutica obteve mais contribuições nas consultas públicas de suas solicitações e apresentou concentração das solicitações em agentes antineoplásicos e imunomoduladores e em anti-infecciosos, sobretudo, para hepatite C e HIV. Também notou-se menor quantidade de demandas da indústria farmacêutica nos Componentes Básico e Estratégico da Assistência Farmacêutica. Os achados apontam o tensionamento entre a expressiva participação da indústria como solicitante, alta mobilização em consultas públicas e ênfase em medicamentos do Componente Especializado e a resistência da CONITEC a essa pressão, com tendência de maior recusa e maior participação de outros solicitantes nos pedidos de ampliação de uso, exclusão e incorporação de medicamentos menos requisitados pela indústria farmacêutica.

El objetivo fue analizar la contribución de la industria farmacéutica a la sostenibilidad del Sistema Único de Salud (SUS), con base en la presión por la incorporación de medicamentos. Para ello, se realizó un estudio descriptivo de las solicitudes de incorporación de medicamentos enviadas a Comisión de Incorporación de Tecnologías en el SUS (CONITEC) entre el 2012 y el 2020. Se analizaron características como la indicación de tecnología, evaluación económica, componente de financiación, consulta pública y decisión de la CONITEC. Los resultados se compararon según el tipo de demandante por prueba estadística. Se analizaron 514 solicitudes, de las cuales 438 se refieren a la incorporación. La industria farmacéutica fue responsable del 37% de las solicitudes y del 33,5% de las incorporaciones. Se observaron diferencias entre los demandantes en cuanto al tipo de evaluación económica y al valor de la relación costo-utilidad incremental, con la mitad de las demandas de la industria por encima del umbral de 3 PIB per cápita/QALY. La industria farmacéutica obtuvo más contribuciones en las consultas públicas de sus solicitudes y presentó una concentración de solicitudes en agentes antineoplásicos e inmunomoduladores y en antiinfecciosos, especialmente para hepatitis C y VIH. También se constató una menor cantidad de demandas de la industria farmacéutica en los Componentes Básicos y Estratégicos de la Asistencia Farmacéutica. Los hallazgos apuntan a la tensión entre la expresiva participación de la industria como solicitante, alta movilización en las consultas públicas y énfasis en los medicamentos del Componente Especializado y la resistencia de CONITEC a esta presión, con una tendencia de mayor negativa y mayor participación de otros solicitantes en las solicitudes de ampliación del uso, exclusión e incorporación de medicamentos menos requeridos por la industria farmacéutica.

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PURPOSE: To summarize the evidence of efficacy and safety of the use of ketamine and esketamine for depression. METHODS: A literature search was performed in Medline, the Cochrane Library, LILACS, and CRD until November 2020. We included systematic reviews with meta-analyses of randomized controlled trials on the use of ketamine and esketamine in adult patients with depression. Two authors independently performed the study selection and data extraction. The AMSTAR-2 tool was used to appraise the quality of included reviews. RESULTS: A total of 118 records were identified, and 11 studies fully met the eligibility criteria. Compared to control, ketamine improved the clinical response at 40 min to 1 week and clinical remission at 80 min to 72 h, and esketamine improved both outcomes at 2 h to 4 weeks. Ketamine and esketamine also had a beneficial effect on the depression scales score and suicidality. For adverse events, oral ketamine did not show significant change compared to control, while intranasal esketamine showed difference for any events, such as dissociation, dizziness, hypoesthesia, and vertigo. Most reviews were classified as "critically low quality," and none of them declared the source of funding of the primary studies and assessed the potential impact of risk of bias in primary studies. CONCLUSION: Ketamine and esketamine showed a significant antidepressant action within a few hours or days after administration; however, the long-term efficacy and safety are lacking. In addition, the methodological quality of the reviews was usually critically low, which may indicate the need for higher quality evidence in relation to the theme.

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O objetivo foi analisar a contribuição da indústria farmacêutica na sustentabilidade do Sistema Único de Saúde (SUS), a partir da pressão pela incorporação de medicamentos. Para tanto, foi realizado estudo descritivo das solicitações de incorporação de medicamentos enviadas à Comissão Nacional de Incorporação de Tecnologias no SUS (CONITEC) entre 2012 e 2020. Foram analisadas características como a indicação da tecnologia, avaliação econômica, componente de financiamento, consulta pública e decisão da CONITEC. Os resultados foram comparados segundo o tipo de demandante por teste estatístico. Foram analisadas 514 solicitações, sendo 438 referentes à incorporação. A indústria farmacêutica foi responsável por 37% das solicitações e 33,5% das incorporações. Foram observadas diferenças entre os demandantes quanto ao tipo de avaliação econômica e ao valor de razão custo-utilidade incremental, com metade das demandas da indústria acima do limiar de 3 PIB per capita/QALY. A indústria farmacêutica obteve mais contribuições nas consultas públicas de suas solicitações e apresentou concentração das solicitações em agentes antineoplásicos e imunomoduladores e em anti-infecciosos, sobretudo, para hepatite C e HIV. Também notou-se menor quantidade de demandas da indústria farmacêutica nos Componentes Básico e Estratégico da Assistência Farmacêutica. Os achados apontam o tensionamento entre a expressiva participação da indústria como solicitante, alta mobilização em consultas públicas e ênfase em medicamentos do Componente Especializado e a resistência da CONITEC a essa pressão, com tendência de maior recusa e maior participação de outros solicitantes nos pedidos de ampliação de uso, exclusão e incorporação de medicamentos menos requisitados pela indústria farmacêutica.

The objective is to analyze the contribution of the pharmaceutical industry to the sustainability of the Brazilian Unified National Health System (SUS), based on the pressure for the incorporation of medicines. For this purpose, a descriptive study was conducted on requests for the incorporation of medicines sent to Commission for Incorporation of Technologies in the SUS (CONITEC) from 2012 to 2020. Characteristics such as technology indication, economic evaluation, financing component, public consultation, and CONITEC decision were analyzed. The results were compared according to the type of solicitor using statistical tests. 514 requests were analyzed, of which 438 related to incorporation. The pharmaceutical industry accounted for 37% of the requests and 33.5% of the incorporations. Differences were observed between the solicitors regarding the type of economic evaluation and incremental cost-utility ratio value, with half of the industry's demands above the threshold of 3 PIB per capita/QALY. The pharmaceutical industry obtained more contributions in public consultations of its requests and presented concentration of requests for antineoplastic and immunomodulatory agents and for anti-infectious, especially for hepatitis C and HIV. There was also a lower number of demands from the pharmaceutical industry in the Basic and Strategic Components of Pharmaceutical Assistance. Our findings point to the tension between the significant participation of the industry as an applicant, the high mobilization of public consultations, the emphasis on Specialized Component drugs, and CONITEC's resistance to this pressure, with a tendency of greater refusal and greater participation of other solicitors in requests for expansion of use, exclusion, and incorporation of drugs that are less requested by the pharmaceutical industry.

El objetivo fue analizar la contribución de la industria farmacéutica a la sostenibilidad del Sistema Único de Salud (SUS), con base en la presión por la incorporación de medicamentos. Para ello, se realizó un estudio descriptivo de las solicitudes de incorporación de medicamentos enviadas a Comisión de Incorporación de Tecnologías en el SUS (CONITEC) entre el 2012 y el 2020. Se analizaron características como la indicación de tecnología, evaluación económica, componente de financiación, consulta pública y decisión de la CONITEC. Los resultados se compararon según el tipo de demandante por prueba estadística. Se analizaron 514 solicitudes, de las cuales 438 se refieren a la incorporación. La industria farmacéutica fue responsable del 37% de las solicitudes y del 33,5% de las incorporaciones. Se observaron diferencias entre los demandantes en cuanto al tipo de evaluación económica y al valor de la relación costo-utilidad incremental, con la mitad de las demandas de la industria por encima del umbral de 3 PIB per cápita/QALY. La industria farmacéutica obtuvo más contribuciones en las consultas públicas de sus solicitudes y presentó una concentración de solicitudes en agentes antineoplásicos e inmunomoduladores y en antiinfecciosos, especialmente para hepatitis C y VIH. También se constató una menor cantidad de demandas de la industria farmacéutica en los Componentes Básicos y Estratégicos de la Asistencia Farmacéutica. Los hallazgos apuntan a la tensión entre la expresiva participación de la industria como solicitante, alta movilización en las consultas públicas y énfasis en los medicamentos del Componente Especializado y la resistencia de CONITEC a esta presión, con una tendencia de mayor negativa y mayor participación de otros solicitantes en las solicitudes de ampliación del uso, exclusión e incorporación de medicamentos menos requeridos por la industria farmacéutica.

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O estudo objetivou analisar a percepção do farmacêutico sobre a sua atuação clínica em Centros de Atenção Psicossocial Infantojuvenil (CAPSi). Foi realizado estudo qualitativo, por meio de entrevistas on-line individuais e semiestruturadas com seis farmacêuticas de CAPSi. As entrevistas foram gravadas, transcritas, analisadas e categorizadas segundo o método de análise de conteúdo. As categorias temáticas foram "Equipe multidisciplinar e as diferentes formas de produção de cuidado", "Inserção do farmacêutico no serviço", "Aspectos que se relacionam ao uso de psicofármacos" e "Nuances do trabalho farmacêutico em rede na infância e adolescência". Os resultados mostram uma gradual mudança de paradigma da atuação do farmacêutico em direção ao cuidado da pessoa em sofrimento mental, culminando em ampla atuação na equipe multidisciplinar. Apesar disso, foi apontada a necessidade de documentos que guiem a atuação clínica deste profissional com o público infantojuvenil.(AU)

This study analyzes pharmacists' perceptions of clinical pharmacy in child and adolescent psychosocial care centers (CAPSi). We conducted a qualitative study with six pharmacists working in CAPSis using online semi-structured interviews. The interviews were recorded, transcribed, analyzed, and categorized using content analysis. The thematic categories were: "Multidisciplinary team and different forms of care delivery"; "The integration of pharmacists into services"; "Aspects linked to the use of psychotropic drugs"; and "The nuances of the network-based approach to pharmaceutical care for children and adolescents". The findings show a gradual shift in the paradigm of clinical pharmacy towards care for people with mental suffering, culminating in pharmacists playing a broad role within a multidisciplinary team. However, the results also highlight the need for documents that provide guidance on pharmaceutical care for children and adolescents.(AU)

El objetivo del estudio fue analizar la percepción del farmacéutico sobre su actuación clínica en Centros de Atención Psicosocial Infantojuvenil (CAPSi). Se realizó un estudio cualitativo, por medio de entrevistas online individuales y semiestructuradas con seis farmacéuticas de CAPSi. Las entrevistas se grabaron, transcribieron, analizaron y categorizaron según el método de análisis de contenido. Las categorías temáticas fueron: Equipo multidisciplinario y las diferentes formas de producción de cuidado"; "La inserción del farmacéutico en el servicio"; "Aspectos relacionados con el uso de psicofármacos"; y "Los matices del trabajo farmacéutico en red en la infancia y adolescencia". Los resultados muestran un cambio gradual de paradigma de la actuación del farmacéutico en dirección hacia el cuidado de la persona en sufrimiento mental, culminando en una amplia actuación en el equipo multidisciplinario. A pesar de ello, se señaló la necesidad de documentos que guíen la actuación clínica de este profesional con el público infantojuvenil.(AU)

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