https://www.um.edu.mt/library/oar/handle/123456789/478 2026-07-23T03:30:46Z https://www.um.edu.mt/library/oar/handle/123456789/148192 Title: Pharmacist-led ambulatory blood pressure monitoring in community pharmacy : an operational feasibility case series Authors: Vella, Michaela; Wirth, Francesca; Camilleri, Liberato; Azzopardi, Lilian M. Abstract: Objectives: To evaluate the operational feasibility of pharmacist-led ambulatory blood pressure monitoring (ABPM) in community pharmacy practice.; Materials and Methods: This operational feasibility case series recruited eligible participants from four community pharmacies located in three geographical districts in Malta over a three-month recruitment period. Process feasibility included recruitment uptake and participant acceptability. Management feasibility included the completion of a valid 24-hour ABPM recording and successful tracking of post-referral outcomes. Pragmatic post-hoc benchmarks were applied: uptake of at least 60%, completion of valid recordings of at least 80%, and post- referral outcome tracking of at least 80%. Exact 95% confidence intervals (CIs) were calculated using the Clopper-Pearson method.; Results: Ten of 20 invited participants consented, corresponding to an uptake rate of 50% (95% CI, 27.2–72.8%). Valid 24-hour ABPM recordings meeting the pre-defined recording quality criteria were obtained for 9 of the 10 participants, corresponding to a completion rate of 90% (95% CI 55.5–99.7). 4 participants were referred for physician review, and post-referral outcomes were obtained for all 4 participants, corresponding to a tracking rate of 100% (95% CI 39.8–100.0). Three of the 4 referred participants reported an intensification of their antihypertensive treatment.; Conclusion: Pharmacist-led ABPM in community pharmacies demonstrated operational feasibility regarding completion of valid recordings and post-referral tracking, although uptake requires improvement. Participant-reported treatment changes should be interpreted as exploratory signals, and larger implementation studies are warranted. 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/148136 Title: Pharmacists’ recommendations for fluid minimisation in critically ill patients Authors: Agius, Ruth; Vella Szijj, Janis; Azzopardi, Lilian M. Abstract: Background: Effective fluid management is essential to reduce the risk of fluid overload, which is associated with worse outcomes in critically ill patients. Intravenous fluids, including hidden fluids, are necessary and frequently used in the intensive care unit (ICU).1 Aim: To assess pharmacists’ interventions related to minimising hidden fluids for patients admitted to the ICU and evaluate the significance of these interventions in their ability to prevent potential adverse drug events (ADEs). Method: The research was conducted during three months in a mixed ICU of an acute general hospital, where clinical pharmacists participate in ward rounds as members of the multidisciplinary team. Recommendations made by pharmacists related to fluid minimisation were compiled. In collaboration with ICU physicians and nurses, the pharmacists suggested fluid minimisation interventions depending on clinical indication and the amount of hidden fluids being administered. The data was classified into the type of intervention, and was evaluated for potential prevention of an adverse drug event (ADE) by an expert panel of healthcare professionals. Results: Pharmacists intervened in minimising hidden fluids for 17 patients (10%) out of 164 patients admitted to the ICU over the three months. Fluid minimisation was required in patients with heart failure and pulmonary oedema, patients with severe renal impairment, patients with brain injury necessitating a neutral fluid balance, and patients with respiratory distress syndrome requiring a conservative fluid strategy to improve lung function, amongst others. Several interventions were recommended by pharmacists for each patient to reduce the total fluid intake, involving multiple medications. These included concentrating infusions when administering via a central venous catheter for all patients (n = 17), opting for a more fluid-restricted enteral feed (n = 5), and converting medications from intravenous to enteral route (n = 3). The recommendations successfully reduced fluid intake by 700 mL over 24 h for a patient with heart failure, and 820 mL over 24 h for a patient with a brain injury. The expert panel found these interventions had a medium probability (77%) or low probability (23%) of preventing a potential ADE. Conclusion: This study highlights the importance of pharmaceutical recommendations in targeted fluid minimisation strategies. The pharmacists' interventions to reduce hidden fluid in specific critically ill patients helped mitigate fluid overload and prevent potential ADEs in this patient group. 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/147967 Title: Assessing confidence of community pharmacists in inflammatory bowel disease management : a cross-sectional study in Malta Authors: Diyab, Aisha; Wirth, Francesca Abstract: Objectives: To evaluate community pharmacists’ confidence in the management of inflammatory bowel disease (IBD) and to identify areas in which pharmacist-led patient education and counselling could be strengthened. Methods: This cross-sectional study was conducted in three phases; questionnaire development and review by an expert panel, reliability assessment, and dissemination to 100 community pharmacies selected through stratified random sampling across Malta. Pharmacists’ confidence across 29 items was assessed using mean rating scores (MRS) on a 5-point Likert scale. Non-parametric analyses examined associations between confidence, demographic variables, and perceived barriers (P < .05 statistically significant). Key findings: Ninety-four pharmacists completed the questionnaire; female (n = 65), > 5 years of community pharmacy experience (n = 56), worked 31–40 hours weekly (n = 39), Master of Pharmacy degree (n = 47). ‘High’ confidence (MRS ≥4/5) was reported for advice on diet and lifestyle, non-prescription medicines for symptom management, medicine storage/stability, and recognizing when referral was required. ‘Moderate’ confidence (MRS 3 to <4/5) was observed for adherence support, relapse, counselling on extraintestinal complications, dosage form administration, corticosteroids, methotrexate, aminosalicylates, and biologics. ‘Low’ confidence (MRS <3/5) was identified for counselling on thiopurines, non-prescription medicines associated with toxic megacolon, vaccines, and pregnancy and women of child-bearing age. The main reported barriers to providing advice were time constraints (n = 70) and patient-related communication challenges (n = 63). Years of experience, hours of practice, and inadequate private consultation space were not significantly associated with pharmacist confidence (P > .05). Conclusions: Community pharmacists were more confident in general counselling and referral-related support than in medication-specific counselling and more complex aspects of IBD care. 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/147898 Title: Pharmacist-led thyroid point-of-care testing in community pharmacy Authors: Vella, Mariah; Wirth, Francesca; Azzopardi, Lilian M. Abstract: Background: Early detection of hypothyroidism through point-ofcare testing (POCT) is relevant for high-risk individuals and those previously diagnosed who may remain uncontrolled due to inadequate adherence or sub-optimal dosing. Establishing pharmacist-led thyroid POCT enables timely screening and ongoing monitoring of hypothyroidism. [excerpt] 2026-01-01T00:00:00Z