Although the quality of reporting of confounding improved in certain aspects, the overall quality remains suboptimal.

Objective: To identify the frequency and scope of extemporaneous compounding practice reported in community and hospital pharmacies.Methods: A systematic literature review was undertaken to identify the prevalence of extemporaneous compounding practice in community and hospital pharmacies, including the reasons of providing compounding services.Results: Nine studies were identified and evaluated in which extemporaneous products prepared by pharmacist could be identified. Most of the studies record that prevalence of extemporaneous compounding practice is very low (less than 5%). Prescribing of compounded medicines occurs more frequently in paediatrics and for special patients' need. The major types of extemporaneous compounding products were dermatological dosage forms and followed by oral solutions and oral suspensions. Reasons for providing compounding practice were to make a customised products that not available commercially and to provide full pharmaceutical care to patients. Issues about the stability of compounded products, accuracy in dose strength and lack of standardised protocol in extemporaneous compounding need to be addressed. Conclusion:Extemporaneous compounding practice are an essential part of pharmacist' competency. These unique skills need to be preserved and regulations that cover rationalised compounding practice is necessary.

PurposeA previous meta‐analysis of randomized trials did not confirm findings from observational studies that suggested that statins reduce the risk of infection. However, animal experiments indicate that statins may be more effective in reducing the risk and/or the severity of infection among patients with diabetes. Hence, we evaluated the effect of statins on antibiotic prescriptions (a proxy for infections) among patients with drug‐treated type 2 diabetes using two confounding‐reducing observational designs.MethodsWe conducted a prescription sequence symmetry analysis and a cohort study using the IADB.nl pharmacy prescription database. For the prescription sequence symmetry analysis, a sequence ratio was calculated. The matched cohort study, comparing the time to first antibiotic prescription between periods that statins are initiated and non‐use periods, was analyzed using stratified Cox regression.ResultsPrescription sequence symmetry analysis of 4684 patients with drug‐treated type 2 diabetes resulted in an adjusted sequence ratio of 0.86 (95% confidence interval [CI]: 0.81 to 0.91). Corresponding figures for the cohort analysis comparing 9852 statin‐initiation with 4928 non‐use periods showed similar results (adjusted hazard ratio: 0.88, 95%CI: 0.83 to 0.95).ConclusionsThese findings suggest that statins are associated with a reduced risk of infections among patients with drug‐treated type 2 diabetes. © 2016 The Authors. Pharmacoepidemiology and Drug Safety Published by John Wiley & Sons Ltd.

ObjectivesIschaemic heart diseases (IHDs) are a leading cause of death worldwide. Although prescribing according to guidelines improves health outcomes, it remains suboptimal. We determined whether interventions targeted at healthcare professionals are effective to enhance prescribing and health outcomes in patients with IHDs.MethodsWe systematically searched PubMed and EMBASE for studies published between 1 January 2000 and 31 August 2017. We included original studies of interventions targeted at healthcare professionals to enhance prescribing guideline-recommended medications for IHDs. We only included randomised controlled trials (RCTs). Main outcomes were the proportion of eligible patients receiving guideline-recommended medications, the proportion of patients achieving target blood pressure and target low-density lipoprotein-cholesterol (LDL-C)/cholesterol level and mortality rate. Meta-analyses were performed using the inverse-variance method and the random effects model. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach.ResultsWe included 13 studies, 4 RCTs (1869 patients) and 9 cluster RCTs (15 224 patients). 11 out of 13 studies were performed in North America and Europe. Interventions were of organisational or professional nature. The interventions significantly enhanced prescribing of statins/lipid-lowering agents (OR 1.23; 95% CI 1.07 to 1.42, P=0.004), but not other medications (aspirin/antiplatelet agents, beta-blockers, ACE inhibitors/angiotensin II receptor blockers and the composite of medications). There was no significant association between the interventions and improved health outcomes (target LDL-C and mortality) except for target blood pressure (OR 1.46; 95% CI 1.11 to 1.93; P=0.008). The evidence was of moderate or high quality for all outcomes.ConclusionsOrganisational and professional interventions improved prescribing of statins/lipid-lowering agents and target blood pressure in patients with IHDs but there was little evidence of change in other outcomes.PROSPERO registration numberCRD42016039188.

Objective: This study was conducted to identify opinion and expectations of pharmacists on providing extemporaneous drug compounding to support pharmacy service. Methods:The study was conducted in Indonesia. Twenty pharmacists, age 40 and above, working in Yogyakarta and Central Java provinces, participated in two focus group discussions (fgd) on extemporaneous drug compounding. Data was collected in June 2016. The data obtained from these groups was subjected to a qualitative analysis to identify recurrent themes pertaining to provision and regulation aspects of compounding. Results:The findings indicated several characteristics of extemporaneous compounding opinion and expectation. These were broadly classified as 5 distinct themes. Evaluation of extemporaneous compounding products was the most prominent theme that was discussed in all of the focus groups. Other themes identified were the scope of compounding practice; materials, equipments and facilities; specialist compounding pharmacy; and prices. The results of this study may offer an excellent guided to designing effective interventions, which would provide regulatory recommendations for compounding pharmacy. Conclusion:This study provided insight into the way that the pharmacists look at the extemporaneous compounding. It is recommended that the issues raised in this study be considered in future regulation of compounding pharmacy in Indonesia.