Patients and survivors of cancer may develop cognitive impairment pre-, intra-, and post-treatment, which is a phenomenon known as cancer-related cognitive impairment (CRCI) or chemobrain. CRCI can adversely affect the quality of life in patients and survivors of cancer. Several factors are associated with CRCI, and the proposed CRCI mechanisms include oxidative stress, dysregulation of inflammatory cytokines, genetic susceptibility, hormone deficiencies and/or psychological distress. Over the past 15 years (2008–2023), our Singapore- and United States-based research team has conducted numerous human studies to evaluate the underlying mechanisms of CRCI through biomarker discovery and validation. Hence, this narrative review aims to elucidate the association between peripheral biomarkers evaluated in our past studies and cognitive function among non-CNS cancer survivors. In summary, plasma levels of brain-derived neurotrophic factor, inflammatory cytokines, and dynamin-1 in plasma extracellular vesicles have shown promising roles in CRCI pathophysiology. These findings indicate that further investigations are required to explore their potential to translate observational results into experimental therapeutics.

Background: Benzodiazepines play a central role in treating insomnia with negative effects, including muscle relaxants and other adverse effects, and lead to dependence when used for a long period. The present study examined the psychiatric outpatient status with each type of hypnotic and compared the efficacy and satisfaction among benzodiazepines, nonbenzodiazepines, a melatonin receptor agonist, and an orexin receptor antagonist using subjective patient assessments to provide more effective treatment for patients with insomnia based on their symptoms.
Methods: A total of 158 psychiatric outpatients who had used hypnotics regularly or irregularly for ≥4 weeks were investigated. Pharmacists interviewed them and assessed the severity of their insomnia using the Athens Insomnia Scale. A questionnaire survey was conducted to clarify the patient’s status of using hypnotics.
Results: A positive correlation was observed between drug efficacy and satisfaction. Patients using intermediate- and long-acting benzodiazepine hypnotics demonstrated the highest satisfaction. Representative reasons for being satisfied with their current hypnotic prescriptions included “having achieved a sufficient therapeutic effect from the first day” and “achieving a sense of good sleep.” Therefore, the efficacy of hypnotics was the most frequent reason. Conversely, some patients were distressed by their adverse effects, including sleepiness during the daytime and difficulty waking up in the morning.
Conclusion: The present results highlight the importance of reducing the symptoms of insomnia and monitoring the efficacy of hypnotics to increase the satisfaction levels of patients receiving insomnia treatment.

Background: This study aimed to evaluate the cost-effectiveness and patient acceptance of a fast-track medication refill (FTMR) service whereby pharmacists and nurses recommend cardiovascular medication refills for stable patients requiring no medication change. It also aimed to create a model that would able to predict which patients are suitable for the FTMR service.
Methods: 472 patients were reviewed between April 2016 and March 2017. For each patient, data were collected on demographics, medical history, symptoms, vital signs, and laboratory results. These data were used to build logistic regression models able to predict whether a patient required medication change. Interviews were conducted with 92 patients to evaluate the time costs, financial costs, patient acceptance, and clinical need for an FTMR service. A cost-effectiveness analysis was performed to estimate the potential cost saving from the introduction of an FTMR service.
Results: The mean age of the study population was 58.7±12.4 years. Among the sample of cardiology patients, 89.4% were on anti-hypertensives; 25.6% were on hypoglycemics, and 59.8% were on cholesterol-lowering drugs. The majority (79%) of patients had no prescription changes recorded during the study period. Our predictive model demonstrated an accuracy level of >96% in the identification of the 50.6% of the cohort judged by physician consultation to be in stable condition, requiring no medication change or dose adjustment. Of the patients requiring no medication change, 53.6% agreed to use the FTMR service. Our analysis found that the FTMR service could lead to savings of 289 USD per 10 person-years, assuming each patient attended a follow-up visit every 6 months.
Conclusion: Within our cardiology clinic, a significant number of outpatients were eligible and willing to utilize an FTMR service, which was found to be a cost-effective improvement. Step-down care of stable patients may help to alleviate the increasing demands and pressure on healthcare providers.

Background: Atrial Fibrillation (AF), which is one of the most common types of arrhythmias, is often undiagnosed because of its asymptomatic nature. This study aims to estimate the prevalence of AF in the Hong Kong elderly population and identify the risk factors for AF.
Methods: This cross-sectional descriptive study was conducted from March 2015 to May 2017 during a summer outreach program to community elderly homes organized by the Chinese University of Hong Kong. Electrocardiogram (ECG) screening was conducted using a hand-held single-lead ECG device (AliveCor).
Results: This study screened 2,798 subjects aged ≥60 years. The mean age was 76.1±8.1 years, 77.4% were female, and 71.1% had primary education or below. Screening detected AF in 5.5% (n=154/2,798) of participants with a mean CHA2DS2-VASc score of 3.8±1.2. Age of ≥85, hypertension, diabetes, and smoking history were found as risk factors for AF. Only 12.7% (n=19/154) of patients with AF were prescribed oral anticoagulants. A history of stroke and male sex were positive factors for anticoagulant usage, while older age often hindered the use of anticoagulants.
Conclusion: The diagnosis rate of AF and utilization rate of anticoagulants were low among the elderly in Hong Kong.

Background: There is no objective and standardized tool for stratification of high-alert medications (HAMs) that reflect each institution’s practice of medication management, drug utilization in the institution, and patient safety protocols in the Korean hospital settings. We aimed to develop the Korean version of the high-alert medication stratification tool (K-HAMST) and assess its content validity and reliability.
Methods: Ten clinical pharmacists from multi-site hospitals completed a two-round Delphi survey to assess the content validity of the translated High-Alert Medication Stratification Tool-Revised. Content validity was demonstrated using the item content validity index and scale content validity index (S-CVI). An expert meeting was conducted to revise the tool to accommodate the clinical practice and workflow in Korea based on the results of the content validity index. Reliability was assessed by calculating the risk scores for 37 HAMs and 37 control medications. The interrater reliability of each medication was assessed using the Kendall’s coefficient of concordance (W).
Results: The initial S-CVI was 0.71. After revision, the final S-CVI of the K-HAMST was 0.92, indicating that the tool has content validity. The HAM scores ranged from 3 to 8 (n=37; median [interquartile {IQR}, 4 [3–5]), whereas the control medication scores ranged from 1 to 2 (n=37; median [IQR], 1 [1–1]). The Kendall’s coefficient of concordance (W) was 0.57, indicating moderate agreement between raters (p<0.001).
Conclusion: The K-HAMST is a valid and reliable tool for assessing and evaluating HAMs in hospital settings.

Background: Since the early 21^st Century, pharmacy practice has experienced critical changes diversely worldwide. This paper reviewed studies aimed at the development of pharmacy education and practice during the last 10 years in Vietnam.
Methods: Analyse data from official sources including Pubmed, Government website, University’s website and books.
Results: The results showed that Vietnam has taken great strides in the legal regulation of clinical pharmacy operations, which are considered a patient-centered pharmacy activity. However, the practice of clinical pharmacy in hospitals, especially direct patient care services, is very limited. Although patient-centered subjects have been added in teaching curricula, the clinical practice experiences of pharmacist students in hospitals have not been addressed.
Conclusion: Vietnam has built a favorable environment for clinical pharmacy practice and education; however, the pharmaceutical services provided by pharmacists remain very limited, especially in the hospital setting.

Background: This study aimed to analyze autologous and allogeneic cell therapies. A gap analysis of source-cell storage regulations and guidelines of allogeneic cell therapies was performed for regulatory authorities in target countries, including the USA, EU, Japan, and Korea.
Methods: Cell-storage regulations and guidelines regarding allogeneic cell therapy products framed by regulatory authorities were comparatively analyzed.
Results: Of 41 cell therapies, 10 allogeneic cell therapies were selected, and their source cells were categorized based on 3 types of cell storage, namely cell bank (n=6) in the USA, Japan, and Korea; cell stock (n=2) in the EU; and drug substance (n=2) in Korea. In the gap analysis of cell storage regulations and guidelines by the selected regulatory authorities, cell storage systems have regulations and guidelines similar to those stipulated by regulatory authorities, except for the regulation of source-cell changes. Most allogeneic cell therapies used cell banks for cell storage. Thus, to ensure the safety of allogeneic cell therapy, more detailed criteria must be established for source-cell changes in cell storage systems.
Conclusion: Regulatory authorities can ensure a safer and more effective supply of therapy products to the public by harmonizing the regulations associated with allogeneic cell therapies.

Background: Sodium restriction is an accepted nonpharmacological strategy for fluid management in heart failure. In an intensive care unit (ICU) setting, high sodium loads have been associated with avoidable derailment of fluid balance. The international guidelines recommend restricting the total sodium intake to <2,000 mg/day or <87 mmol/day for patients with heart failure. Previous studies in the ICU have shown a high median daily sodium administration (approximately 225 mmol/day); however, there is a paucity of data on patients with heart failure with reduced ejection fraction (HFrEF).
Methods: A retrospective observational cohort study was performed in an tertiary teaching hospital network over a 3-month period. Data on intravenous (IV) fluids, IV medicines, medicine diluents, line flushes, and oral/rectal medicines with known high sodium were obtained. The amount of sodium administered each day from these sources was calculated and compared with the current guidelines.
Results: A total of 116 patients were reviewed, with an even distribution of patients from cardiac (57 patients) and noncardiac units (59 patients). The median sodium administration was 5.2 mmol/day (IQR, 0.00–15.55). For cardiac versus noncardiac units, the medians were 3.74 mmol/day (IQR 0.00–11.45) and 7.0 mmol/day (IQR 0.00–18.99), respectively. The primary sources of sodium were IV fluids, line flushes, and oral or rectal medicines.
Conclusion: This study suggests that patients with HFrEF admitted to a tertiary hospital network are not receiving sodium greater than the current recommendations mentioned in the guidelines. A pharmacist’s review on the amount of sodium administered might be a clinical pharmacy safety initiative to ensure that patients with HFrEF do not receive excessive sodium from inadvertent sources.

In this study, presents an approach to enhance compliance with the Joint Commission International Accreditation Standards for Hospitals, 7th edition, regarding medication recall, particularly vaccines. It highlights the hospital’s initiative to develop a standardized streamlined process and implement a computerized centralized vaccine tracking system (VTS) to improve the traceability of administered vaccines up to the patient-specific batch/lot level. When needed, in the case of medication recall, this system allows the extraction of patient data and the batch and lot numbers of vaccines. Compliance to the use of the VTS was monitored, and further improvement initiatives such as training and feedback were implemented to further enhance and sustain the project. After the implementation of the project and monitoring for 11 months, the compliance on the documentation of vaccine batch and lot numbers significantly increased from 21% to 75% in the period from February 2021 to December 2021. In conclusion, the use of the centralized VTS application program, which can track all vaccines administered up to the patient-specific batch/lot level, improved compliance and provided a clean database of documentation that can be readily generated to track patients in the case of vaccine recall.