Anticholinergic medications are widely used to treat a range of conditions. However, there are many medications that have anticholinergic effects even when this is not their main purpose. Taking multiple medications with these effects, known as anticholinergic burden, can increase the risk of delirium, falls and dementia – particularly in older people.

Published in BMJ Medicine, researchers at the University of Leeds, University of Liverpool and Bradford Institute for Health Research have developed the Anticholinergic Medication Index (ACMI) to score a patient’s anticholinergic burden, based on the risk of delirium or falls. Researchers designed the ACMI to be embedded into electronic patient record systems, enabling healthcare professionals to efficiently prioritise patients with a high score to optimise their medicines.

First author Dr Kate Best, Associate Professor of Applied Statistics at the University of Leeds, said:

“Approximately 50% of older adults are prescribed at least one anticholinergic medication annually in the UK. While an anticholinergic medication might sometimes be the best treatment, with so many drugs that have this unintended side effect, anticholinergic burden can easily accumulate and pose a significant risk.

“Falls and delirium can be devastating for the health and wellbeing of older people, with considerable cost to the NHS. For patients with multiple health conditions, it may be reassuring to know there is a tool that can flag when they might need a medication review and support them to live well for longer.”

The research team piloted the ACMI at GP surgeries in Bradford to automatically generate a list of patients aged 65+ with their ACMI score, the anticholinergic medicines contributing to the score and their one year predicted risk of fall or delirium. Without the tool, this information would have needed to be worked out patient by patient before pharmacists could use it to prioritise those most at need for a structured medication review.

Professor Andy Clegg, Head of the Academic Unit for Ageing and Stroke Research and Co-Director of HDR UK North and NIHR ARC Yorkshire and Humber said:

“Anticholinergic burden is a significant concern for older people, contributing to major health problems including delirium, falls, and dementia, alongside other side effects such as constipation, problems emptying the bladder, and dry mouth. As a consultant geriatrician, I frequently see patients on multiple anticholinergic medications that may be contributing to delirium and falls.

“We have designed the ACMI to integrate with electronic patient record systems and have successfully deployed the tool to support safer prescribing in primary and secondary care. Our ACMI has been designed to be built into EPR systems, rather than using a separate online system, providing a highly efficient automated calculation for busy clinicians to make the best decisions for their patients.”

Dr Aseel Abuzour, Senior Research Fellow at the University of Leeds, and Professor Clegg also lead on a study embedding ACMI directly into hospital electronic patient record systems at two NHS Trusts, with support from the National Institute for Health Research (NIHR). The calculator, known as Anticholinergic Medication Index Clinical Decision Support System (ACMICS), is now live in two Trusts and in use.

Dr Abuzour said:

“Very few clinical prediction models are ever implemented in clinical practice. ACMICS is one of the few that has been. It is embedded directly within the EPR, appearing at several points across the system according to clinical workflow, and automatically recalculates whenever an anticholinergic is prescribed or stopped. Its design was informed by observations of clinical practice rather than assumptions about where the score would be most useful. We have also produced a technical specification so other organisations can develop an equivalent solution within their own EPR.”

The ACMI was developed and tested using health data from nearly 750,000 adults aged over 65 years, making it one of the largest studies of its kind. To develop the index, researchers accessed de-identified routinely collected healthcare data through Connected West Yorkshire, an anonymised linked dataset containing primary and secondary care records. It was then tested using a large national dataset of patients in Wales held within the Secure Anonymised Information Linkage (SAIL) Databank.

Professor Sir Munir Pirmohamed, Co-Director of HDR UK North and David Weatherall Chair in Medicine at the University of Liverpool, said:

“We have known about the risks associated with anticholinergic medicines for many years. The challenge has been turning that knowledge into practical action that can reduce the risks for patients. The ACMI provides a real opportunity to make that happen, and it is one we should grasp.”

The team are currently piloting the ACMI tool in several geriatric medicine and orthopaedic hip fracture hospital wards to examine the feasibility of wider roll-out in secondary care.

The post New NHS-ready medication risk tool could cut falls and delirium in older people appeared first on Pharmacy Update Online.

The research, led by Murdoch Children’s Research Institute (MCRI) and the National Allergy Centre of Excellence (NACE) in partnership with 10 paediatric public hospitals across Australia, found 35 per cent of infants with a recent reaction to peanut and positive allergy test didn’t react during an oral food challenge. Without the challenge, these children would have likely continued to avoid peanut in case they triggered an allergic reaction.

MCRI Population Allergy Group Senior Research Clinician and ADAPT Medical Lead Dr Tim Brettig said the study highlighted the importance of confirming a peanut allergy before committing children to long-term treatment.

“We found more than one third of infants who were suspected to have peanut allergy based on their history and initial tests no longer reacted when they underwent a supervised food challenge,” he said. “Being able to identify those children early allows them to avoid an unnecessary allergy label and the burden of avoiding peanut.”

The findings form part of a study evaluating the ADAPT Peanut Oral Immunotherapy Program, which was launched in 2024 by the NACE, hosted at MCRI. ADAPT is the first peanut allergy treatment program offered in Australian public hospitals for infants outside of a clinical trial setting.

As part of this evaluation, 1275 infants under 18 months old were assessed with 778 undergoing an oral food challenge. The infants presented at participating hospitals across Victoria, New South Wales, Queensland, South Australia and Western Australia. During a food challenge, infants receive increasing doses of peanut under medical supervision to check for an allergic reaction.

Published in The Journal of Allergy and Clinical Immunology: In Practice, it found while 65 per cent of babies had a reaction, including 12 per cent who experienced anaphylaxis, all episodes were safely managed by the teams conducting the food challenges.

The 35 per cent who had no reaction were considered peanut tolerant and could have their allergy label removed, allowing them to regularly eat peanut in an age-appropriate form, such as peanut butter.

Almost all babies who reacted proceeded to peanut oral immunotherapy, a treatment involving daily doses of peanut to build tolerance, with 97.5 per cent successfully starting treatment at a dose guided by their challenge results.

Australia has some of the highest reported rates of childhood food allergies in the world with peanut allergy affecting about one in 30 children.

MCRI Population Allergy Group Leader and NACE Director Professor Kirsten Perrett, also the ADAPT Program Lead, said the results had implications for how peanut allergy was managed in Australia.

“Oral food challenges are not currently used routinely for every infant with suspected peanut allergy,” she said. “But our results show that clinical history and allergy testing alone were not enough to accurately diagnose peanut allergy in many cases. A supervised oral food challenge should be routinely considered to confirm the diagnosis before an infant starts oral immunotherapy.

“With peanut allergy one of the most common childhood food allergies, it’s particularly important that we have an accurate diagnosis when a baby first shows signs of a possible peanut allergy. We want to reduce the burden of food allergy for children and their families, and the ADAPT Program is a step in this direction.”

When Leah and Jake introduced their infant son to peanuts the reaction was almost immediate.

Just five months at the time, Arthur’s face reddened and hives appeared on his shoulders and under his nose. The reaction settled within an hour, but the family was left unsure as to whether Arthur had a peanut allergy.

“Our GP referred us to an allergy specialist who took skin prick and blood tests,” Leah said. “The results suggested Arthur had a high risk of reacting to peanut, and we were advised to avoid it while we awaited further tests.”

Arthur, now one years old, was referred to the ADAPT Program at The Royal Children’s Hospital (RCH). Despite his earlier side effects and allergy test results, Arthur tolerated the supervised oral food challenge without reacting. His suspected peanut allergy label was removed.

“We were understandably anxious going into the challenge, because we didn’t know how Arthur would respond,” Leah said.

“It’s a huge relief knowing Arthur can tolerate peanut and we can move forward without the uncertainty of managing a suspected allergy. Having the opportunity to find out he could tolerate peanuts has made a real difference to our family.”

Needing to travel to Melbourne for the food challenge, Leah hopes more families, particularly those in regional and remote areas, will have similar opportunities to clarify their child’s diagnosis.

The NACE and National Allergy Council (NAC) were funded by the Federal Government in 2022 to transform allergy research and clinical care to help save lives, improve health and reduce the burden of allergic disease.

If families suspect their baby has a peanut allergy, they are encouraged to talk to their GP, who might refer them to a paediatric allergy specialist.

Support MCRI’s end-of-year Allergy Appeal to help more children start school allergy-free. Donate today

Researchers from John Hunter Children’s Hospital, The Children’s Hospital at Westmead, Royal Prince Alfred Hospital, SA Women’s and Children’s Network, The Royal Children’s Hospital, Campbelltown Hospital, Perth Children’s Hospital, Fiona Stanley Hospital, Children’s Health Queensland, and Sydney Children’s Hospital, Randwick also contributed to the findings.

Publication: T.W. Brettig, E. McDonald, D. West, R. Bhatia, I. Bosi, A. Cheung, H. Czech, L.S. Ford, C.H. Katelaris, M.D. O’Sullivan, J. Peake, K. Preece, P. Quinn, J. Smart, S. Swamy, B.K. Wainstein, M. Wong and K.P. Perrett. ‘An Oral Food Challenge should be routinely considered for accurate diagnosis of peanut allergy in infants prior to Oral Immunotherapy: Evaluation of the ADAPT Peanut OIT Program,’ The Journal of Allergy and Clinical Immunology: In Practice. DOI: 10.1016/j.jaip.2026.08.044

*The content of this communication is the sole responsibility of MCRI and does not reflect the views of the NHMRC.

Available for interview:

Dr Tim Brettig, MCRI Senior Research Clinician, Population Allergy and ADAPT Medical Lead

Professor Kirsten Perrett, MCRI Group Leader, Population Allergy, NACE Director and ADAPT Program Lead

Leah and Jake whose son Arthur, 1, had his suspected peanut allergy diagnosis removed

The post A third of babies have peanut allergy diagnosis removed appeared first on Pharmacy Update Online.

Nicotine pouch usage among “ever users” — individuals who have used the product at least once — rose from 16.4% to 31.1%, while current nicotine pouch use increased from 3% to 10.2% during the study period.

The lead investigator for the study is Ashley Merianos, PhD, professor in the University of Cincinnati School of Human Services. The study used repeated cross-sectional analysis of 2021 and 2024 YouGov survey data. It included a nationally representative sample of adult tobacco users in the United States.

The study findings were published recently in the scholarly journal Addiction.

Nicotine pouches contain a powder made of nicotine, flavorings and other ingredients. A pouch is placed between the upper or lower lip and the gum. Saliva releases the nicotine, which  is absorbed through the gums and lining of the mouth.

In 2024, use was more common among men, adults ages 21 to 45 and people currently using tobacco products, especially smokeless tobacco users. Merianos says these patterns suggest that nicotine pouches may be used alongside other forms of tobacco for some users.

Researchers say continued monitoring is needed to track nicotine pouch use, understand how pouches fit into people’s overall nicotine use and identify populations with the highest rates of use.

Other study investigators include Joshua Lambert, PhD, associate professor in the University of Cincinnati College of Nursing, and Dan Petrovitch, PhD, postdoctoral researcher at Texas Tech University. Investigators participating in the study at the National Institutes of Health include Kristen Hamilton-Moseley, PhD, Bambi Jewett, MSN, and Kelvin Choi, PhD.

“Our data show that what was once considered a niche nicotine product is becoming a mainstream product among U.S. adult tobacco users,” explains Merianos. “Nicotine pouches are often marketed as tobacco-free alternatives, but there are still important unanswered questions regarding their long-term health effects and addiction potential.”

“Our main results showed that nicotine pouch use is increasing rapidly,” adds Merianos.

Younger adults are driving much of this growth, with adults ages 21 to 45 significantly more likely to report both “ever use” and current nicotine pouch use compared with adults over 60, adds Merianos.

Current tobacco use, not surprisingly, was one of the strongest predictors of nicotine pouch use. This suggests that these products are primarily being adopted by people who are already using other tobacco products, whether cigarettes or e-cigarettes, says Merianos.

“Most interestingly, smokeless tobacco users were the most likely to use nicotine pouches, indicating overlap between traditional oral tobacco products and newer nicotine pouch products,” says Merianos. “Dual- and poly-tobacco use remain important concerns, as our study showed that many nicotine pouch users also report using other tobacco products.”

Across groups, men had a higher prevalence of “ever use” and current use of nicotine pouches. That trend was also the case with smokeless tobacco use in general, whether snus — a Swedish smokeless and spitless tobacco product — or snuff.

Nicotine is a stimulant that can impact the developing brain, and the human brain isn’t fully developed until age 25. This is especially relevant for tobacco users ages 21–24. The group that included this age range saw a strong increase in nicotine pouch use.
“We don’t yet know the long-term health consequences, and we also don’t know the long-term addiction potential,” explains Merianos. “If a young adult who has never smoked or used smokeless tobacco starts using nicotine pouches, will they become addicted to nicotine? And will they then switch to other products? That’s what we’re trying to figure out in the long term.”

Merianos says public health officials must continue surveillance of emerging nicotine products and how they fit into the broader tobacco marketplace.

“The tobacco industry is very strategic,” says Merianos. “They are always going to have new marketing tactics and new products. Look at what happened with electronic cigarettes. Now there are these nicotine pouches, which are exploding on the market.”

Healthcare providers and other professionals across the Midwest — and across the United States — are increasingly likely to encounter patients using nicotine pouches. “The question is: Are they prepared to discuss both the knowns and unknowns surrounding these emerging products?” asked Merianos.

Image: Ashley Merianos, PhD, professor in the University of Cincinnati College of Education, Criminal Justice and Human Services.

View more Credit: Photo courtesy of the University of Cincinnati.

The post Who uses nicotine pouches? appeared first on Pharmacy Update Online.

In 2019, the American Diabetes Association (ADA) updated its Standards of Care to encourage prescribing sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) for adults with type 2 diabetes who are at high risk for cardiovascular disease, heart failure or chronic kidney disease. Researchers examined how endocrinologists’ prescribing patterns for these patients changed before and after the update and whether those changes varied among high- and low-scoring LKA participants.

The study found:

• From 2018 (the year before the guideline update) to 2022, overall SGLT2i prescribing for patients with type 2 diabetes targeted by the updated recommendations increased by 11.4 percentage points compared with patients not targeted by the recommendations. This comparative increase was 2.4 percentage points for GLP-1RA prescribing.
• The increase in SGLT2i prescribing was more than 30% larger among patients treated by endocrinologists with high (top quartile) first-year LKA scores compared with those with low (bottom quartile) scores. These score differences were not associated with increases in GLP-1RA prescribing.

“These therapies can help prevent some of the most serious and costly cardiovascular and kidney complications of diabetes, including those that can lead to hospitalizations, disability and premature death. Yet even though they are widely recommended for high-risk patients, many who could benefit most from these drugs are not receiving them,” said senior author Rozalina McCoy, MD, MS, an endocrinologist, Associate Professor of Medicine and Vice Chief of Clinical Research in the division of Endocrinology, Diabetes and Nutrition at the University of Maryland School of Medicine. “Our findings about which physicians are most likely to prescribe these medications underscore the importance of continuous learning and staying current with emerging evidence to help ensure patients receive the best possible care.”

The study analyzed Medicare claims data from 2017 through 2022 and included 1,061 endocrinologists caring for 177,284 Medicare beneficiaries with type 2 diabetes. Researchers compared prescribing patterns among patients targeted by the updated ADA treatment recommendations with those among patients not targeted and examined those patterns next to endocrinologists’ subsequent first-year LKA performance.

The findings join other newly published research examining possible connections between LKA participation and patient care among endocrinologists, which found that 95% of doctors surveyed reported learning while answering LKA questions. Sixty-eight percent said they were motivated to study by the real-time feedback they received through those assessments, and 53% reported that LKA participation resulted in changes or planned changes to patient care, according to findings published in August in Journal of the Endocrine Society.

“Our findings demonstrate that high scores on an ABIM assessment signal that a physician has kept current with medical knowledge in their field,” said lead author Bradley Gray, PhD, ABIM Principal Health Services Researcher. “Taken together, these studies suggest that continuing certification activity may play an important role in how quickly new evidence reaches patients and offer opportunities to better understand how physicians keep pace with advances in medicine.”

The post Endocrinologists who demonstrate greater medical knowledge more likely to prescribe a recommended treatment for patients with type 2 diabetes appeared first on Pharmacy Update Online.

Now, patients are more likely to see a new doctor every time. According to GPs Francesca Frame, Peter Tate and Phil Whitaker in The Doctor’s Communication Handbook, the shift from relationship-based medicine to fragmented and transactional care is undermining good healthcare.

The reasons for this are varied and have been mounting in the last ten years – including workforce shortages, reduced appointment times and a proliferation of remote consultation methods.

“The UK system of general practice used to be an international benchmark of high-quality, low-cost healthcare centred on longitudinal relationship-based medicine, but this is in sharp decline,” the authors explain to their peers in the book, now in its ninth edition and considered by many in the medical community as an industry must-have.

“The loss of continuity of care has not only had an impact on a patient’s experience and outcome, but on our ability to consult effectively. For those of us who have had the opportunity to experience continuity with our patients, we know the value of it.”

Why does it matter?

There is empirical evidence that suggests continuity of care leads to better patient outcomes. A systematic review in the BMJ, for example, found that increased continuity with a doctor was associated with lower patient mortality – meaning the more time spent with the same clinician, the greater the benefits. In fact, a large-scale Norwegian study found up to 25% reduction in mortality and 30% reduction in emergency hospital visits.

“Imagine if this level of benefit was seen with a new drug or treatment,” Drs Frame and Whitaker say, “it would be on newspaper front pages as the new miracle-cure.”

Besides the data, they say trust built over time makes difficult conversations easier and uncertainty more bearable.

“Difficult conversations become so much easier when trust has already been earned and established. Patients are more likely to follow our advice because they know it worked last time, and so they have confidence it will again. Patients also better understand the thorny issues of medical uncertainty when discussed with a trusted clinician, and they more easily accept the fact that sometimes we are not right and we will make the wrong treatment choices, or a mistake, because they know us as people and individuals in our own right,” they explain.

And the benefits run in both directions, Drs Frame and Whitaker argue. For clinicians, continuity saves time and crucial brainpower – rather than starting from scratch each visit.

“For us as clinicians, there are obvious benefits; we already know our patients, we are not having to establish a new rapport and relationship in every consult, and we can use our previously learned knowledge of a patient’s situation, background, medical history alongside their previously elicited ideas, concerns and expectations,” Drs Frame and Whitaker say.

What is behind the shift?

General practice is undergoing what the authors call ‘something of a seismic shift’, as small, independent practices are absorbed into larger organisations. At the same time, patients increasingly consult a wider range of healthcare professionals, sometimes instead of a doctor, further fracturing any single point of care.

Remote consultation technology further compounds the problem, they suggest. The convenience of reaching a clinician through a few clicks of a smartphone screen lowers the barrier to seeking care, but the authors warn this can also encourage ‘doctor-shopping’ – patients consulting multiple clinicians to avoid continuity altogether, sometimes guided by online forums where doctors are negatively portrayed.

Artificial intelligence adds yet another layer of complexity. In fact, England’s chief medical officer, Chris Whitty, raised concerns earlier this year that GPs are spending consultation time ‘undoing’ misinformation confidently delivered by large language models such as ChatGPT.

However, the authors tell colleagues not to be unduly alarmed, and suggest AI is simply the latest source feeding into patients’ pre-existing ideas, concerns and expectations, such as family anecdotes, things they’ve read or advice from a well-meaning neighbour. Understanding these influences is a concept, they argue, that has always been central to good consulting.

“Any clinician who wants to be effective must be interested in people and not merely diseases. They must be committed to their patients’ welfare, willing to search out their patients’ beliefs, and it follows that they must also be willing to listen to whatever problems their patients bring to them. This is an intensely personal form of healthcare, which is under increasing pressure in the resource-squeezed NHS of today. The treatment of a disease can be largely impersonal, but the care of a patient is entirely personal. We have an ethical duty to keep it that way.”

What are the stakes?

All this amounts to a healthcare system that is fractured and patients who are often lost on how to navigate it, they suggest.

While individual clinicians must work within the systems, Drs Frame and Whittaker argue strongly that continuity should be championed at any opportunity before it disappears for good.

“Continuity can exist in many shapes and forms, but we must protect and promote the ability for a patient to have continuity with their clinician. We have seen throughout this book how continuity improves patient outcomes, and how it also makes our job more effective,” they say.

“If we lose that continuity, we will lose much more than most people realise. Healthcare that shifts to a transactional, access-first, one-size-fits-all approach will be an infinitely poorer place to be cared for and to work in. We can only hope that those who wield power and control within the NHS recognise this before it is lost.”

These doctors suggest that continuity of care is not just for nostalgia’s sake, it is a measurable feature of good medicine that modern healthcare systems are pulling apart.

“We all have various opinions on the direction of travel in the current NHS system. The inevitable fallout of a collapsing social care system is wreaking havoc with community services and hospital capacity alike. Resources are scarce and often misdirected, and policy changes on political whim and agenda. Politics is far outside our remit here, but to ignore the impact of major large-scale and system-wide change on the dynamics of the clinician-patient consultation would be both wishful thinking and naïve.”

The post The collapse of continuity of care in UK medicine has negative impact on patient outcomes, GPs warn appeared first on Pharmacy Update Online.

Conducted by Martina Dickson, Dean Cairns, Ye Cao, Jennifer M. Robinson, and Melissa McMinn, the study is the first to apply the concept of science capital in the UAE context. Science capital encompasses the social, cultural, and economic resources that shape a person’s relationship with science. These include attitudes toward science, confidence in engaging with it, participation in science-related activities, exposure to science through media, connections with people who have scientific knowledge, and an understanding of the value of science qualifications.

To investigate how these resources relate to students’ career aspirations, the researchers surveyed 429 middle and high school students in government schools in Abu Dhabi. The questionnaire included 11 items adapted to the UAE context to measure different aspects of science capital. Students were also asked whether they would like to pursue a job involving science in the future. The researchers used exploratory factor analysis to examine the structure of the science capital measure and logistic regression to assess its relationship with career aspirations.

The results suggest that science capital scale is a meaningful and reliable measure in the UAE context. Students reported particularly positive views of science’s practical value: 90% agreed that a science qualification could help them obtain a wide range of jobs, while 83% said science was useful in everyday life. Teachers also emerged as an important source of encouragement, with 82.3% of students agreeing that their teachers encouraged them to continue studying science. However, opportunities to engage with science outside the classroom appeared more limited. Only 26.4% of students reported that they were currently members of,  or had previously participated in, an after-school science club.

The central finding was a significant positive relationship between science capital and students’ aspirations for science-related careers. The statistical model explained 39% of the variation in career aspirations, highlighting science capital as an important factor associated with students’ plans for the future.

The study also highlights the role of schools in shaping students’ relationship with science. In the UAE sample, school-related influences appeared more prominent than family influences in shaping students’ science attitudes and dispositions. This differs from patterns reported in earlier UK research, where family and parental influences have played a prominent role in young people’s engagement with science. The authors suggest that teachers in the UAE may be particularly well placed to help students recognize the range of educational and career opportunities that science can offer.

These findings have practical implications for science teaching. Schools could help strengthen students’ science capital by connecting classroom learning with everyday life, explaining how science qualifications can open doors to different careers, and introducing students to a wider range of science-related professions. Opportunities to meet people working in scientific fields and participate in science clubs or other hands-on activities could also help students build connections with science beyond their lessons. The authors further highlight the potential value of involving families and local communities, giving students a voice in curriculum design, and providing professional development to help teachers incorporate science-capital-informed approaches into their practice.

The researchers acknowledge that the study has limitations. Because the sample came from government schools in Abu Dhabi, the findings cannot be assumed to represent all students across the UAE. They call for further research involving larger samples, schools other emirates, and closer examination of differences across demographic groups.

Overall, the study provides initial evidence that science capital is relevant to understanding students’ science career aspirations in the UAE. By highlighting the role of school science and teachers, it points to practical ways educators can help young people see a place for science in their future, and potentially encourage greater participation in STEM education and careers.

This work was funded by an AARE (Abu Dhabi Research Excellence) ASPIRE Grant Funding Award (AARE 2020-104).

The post From the classroom to future careers: how science capital shapes STEM aspirations in Abu Dhabi appeared first on Pharmacy Update Online.

CANS covers disorders that develop from repetitive movements, awkward postures or external forces such as vibrating tools. They significantly affect working populations worldwide.

Workplaces heavily invest in ergonomic interventions, such as office furniture changes and biomechanical or ergonomic education, to help office workers with CANS.

No clear benefit for pain, function or sick leave

Led by researchers from the University of Technology Sydney, the review analyzed 20 trials, 16 of which looked at non-specific CANS, involving a total of 2,478 people with work-related CANS. The participants included workers who frequently use computers in their job.

The review found that, compared with no treatment, usual care or placebo, ergonomic interventions may make little to no difference to short-term pain. They probably make little to no difference to functional status, sick leave or recovery.

Low-certainty evidence points to possible benefits for quality of life and health care use. Results were mixed, however, and one analysis showed a reduction in health care consumption while another showed little to no difference.

Overall, ergonomic approaches appear less effective than exercise, though small benefits may occur in specific subgroups, such as people with rotator cuff tendinitis.

“When we pooled the best available trials, ergonomic interventions made little to no difference to pain, function, recovery or sick leave compared with no treatment. The certainty of that evidence ranges from low to moderate, so this is a clear signal that the case for these interventions is weaker than many people assume,” says Dr Poonam Mehta, lead author from University of Technology Sydney. “We’d need more evidence to confirm this, as there is not much high-quality research in this area.”

A big investment for companies

Many companies push for and invest heavily in ergonomic interventions. Some examples include ergonomic training, sit-stand desks and specialized equipment such as mouses and ergonomic keyboards.

Repetitive strain injuries can lead to worker absenteeism, a higher turnover and more compensation claims. Workers can also be less productive when they’re in pain.

“Ergonomic interventions can be a big financial burden for organizations,” continues Dr Mehta. “Our findings suggest that, on current evidence, these measures alone shouldn’t be expected to reduce pain or sick leave in the short term. Employers may want to weigh that against the cost.”

Co-author Dr Peter Stubbs also stated that “the methodological flaws and high risk of bias downgrade the confidence in the results.”

No data were available on recurrence of injury or complaint, and little data on work-related outcomes beyond sick leave.

Ergonomic strategies may still have value in specific subgroups, or as part of a broader workplace or rehabilitation program, but supporting evidence is limited and uncertain.

The authors call for high-quality, well-designed trials to establish the role of ergonomic strategies in managing CANS.

The post Little evidence that common workplace ergonomics help appeared first on Pharmacy Update Online.

Three routes into research

At the Pharmacy Research Showcase, three people whose research is supported by Pharmacy Research UK (PRUK) described their own journeys. A renal pharmacist, a mental health pharmacist and a pharmacy technician each showed how funding, protected time and good support can help turn a clinical question into a viable research project.

Tackling the medication burden in kidney disease

Cathy Pogson, a renal pharmacist in Portsmouth, holds a PhD fellowship jointly funded by Kidney Research UK and PRUK. Her focus is the very high medicines burden carried by people under the care of nephrologists. Many take 10 to 14 regular medicines, see several prescribers and often face low health literacy and social deprivation. Patients on dialysis tolerate more medicines than most, she said, but beyond about 14 a day the burden becomes too much and quality of life falls.

Structured medication reviews in primary care are a valuable service, but they may not suit this group. Renal patients spend a lot of time in hospital, and those on dialysis already see their specialist nephrology team three times a week. Do they really want to see a non-specialist to have their medicines reviewed? she asked.

Ms Pogson’s path was not straight. An NIHR internship of one day a week for six months refreshed her research skills. Her first PhD application was turned down. She was not ready, she admitted, and the extra time made her research stronger. A pre-doctoral fellowship followed, during which she published a scoping review in the British Journal of Clinical Pharmacology, completed research methods modules and formed a patient and carer group.

That group transformed her understanding of the patients’ experiences. Patients’ comments included: “When I go to the GP, everything flags red. This is scary. I don’t know what anything is for”, and “Non-kidney specialists choose the wrong medicines for me. I only trust kidney people to offer me the correct medicines”. Another said, “My medicines come from many suppliers. This affects me doing things. I must wait in all day for them to arrive”. Moreover, the NHS App does not list the complex medicines supplied by hospitals, such as transplant drugs, so lists are only partial at best.

Ms Pogson’s PhD now uses the person-based approach, a framework built around users’ needs. With Health Research Authority (HRA) approval in place, she is setting up studies at Portsmouth, King’s and University College London (UCL). This mix gives her access to both coastal deprivation and wider ethnic diversity, she explained. Co-design workshops will follow, with the aim of producing a new medicines optimisation intervention.

Stopping antidepressants safely

Sarah Jones, a former specialist mental health pharmacist who now teaches at The University of Bath, holds a PRUK PhD studentship. She has had a longstanding interest in deprescribing of antidepressants. In some areas up to 20% of adults take an antidepressant, but most research on withdrawal effects does not reflect primary care, where most prescribing happens. Patients told her they felt caught in the middle of a heated academic debate and simply wanted better information. Her research project is designed to look at how antidepressant deprescribing is managed in primary care and how patients who want to stop their treatment can best be supported.

A prospective, mixed methods study will follow patients for six months from the start of a reduction, using questionnaires at one, three and six months and interviews with a subgroup. It will also interview pharmacists and nurse prescribers, whose views are often missing.

She was open about the challenges. A stream of new papers has meant constant rethinking, and a withdrawal rating scale that “everybody uses” turned out to exist in many versions. Studying half-time has also left little space for deep thinking.

A technician’s route to a master’s

Debbie Sutton, a pharmacy technician, built her trust’s clinical trials pharmacy team from scratch and later moved into research development. A PRUK bursary now funds her master’s degree and buys protected time. Her dissertation will compare medication histories taken to check clinical trial eligibility with those taken for non-research patients, in terms of pharmacy oversight and training requirements.

Her biggest hurdle was access. Technicians usually qualify through vocational routes, and few universities accept equivalent experience or explain what it means. She now plans to study the problem. Her tips for applicants were to read the guidance in full, pick a project you care about, talk to peers and the NIHR Research Support Service, involve your employer and Research and Development (R&D) department early, and believe in yourself.

Common threads

The three stories share some lessons. Each research question came from everyday clinical practice. Patient involvement shaped every project. Protected time, good supervision and professional networks made the work possible, and setbacks along the way often made it stronger. For anyone thinking of applying, PRUK’s funding round usually opens in November and closes in March.

Pharmacy Research Showcase

The Pharmacy Research Showcase was a one-day event organised by the NIHR-Supported Incubator for Pharmacy Professionals which brought together policy-makers and researchers to share experiences and insights. It was held on 22^nd October 2026 at the Royal College of Pharmacy headquarters in London.

Image: Cathy Pogson

The post PRUK-supported research projects appeared first on Pharmacy Update Online.

A research team led by Professor Daiju Ueda at Osaka Metropolitan University’s Graduate School of Medicine in collaboration with The University of Texas’ MD Anderson Cancer Center asked five LLMs (GPT-5.4, Claude Sonnet 4.6, Gemini 3.1 Flash, Llama 4, and MedGemma) to recommend up to three FDA-approved drug products for a range of simulated scenarios.

Although an average of 5.5 FDA-approved products were available for each specified active ingredient, a single product accounted for an average of 97.5% of first-choice recommendations across the tested scenarios and models.

“The recommendations were mostly for brand-name drugs, those highly visible in Google searches, and treatments with dedicated Wikipedia pages,” Professor Ueda said.

The LLMs also tended not to recommend products with later FDA approval and those more commonly prescribed in actual physician practice. The study also identified recommendations that were inconsistent with regulatory information, including discontinued products.

The researchers then evaluated how much this could potentially cost patients using US data. They looked at a scenario where physicians’ prescribing behavior was performed in accordance with the LLMs’ recommendations.

“We found that annual acquisition costs would increase by approximately US$55.6 million,” Professor Ueda summarized. “This represents a 1,019% increase in the cost of purchasing these prescriptions.”

When instructed to prioritize lower-cost or generic products, the models shifted their recommendations accordingly; however, recommendations remained concentrated on a limited set of products.

“Our findings highlight the need to evaluate healthcare AI for biases in product selection and the handling of cost and regulatory information,” Professor Ueda said. “Combining AI systems with trusted drug information sources and human oversight may help support more appropriate medication choices.”

The post AI’s preference for drugs with a strong online presence may cost millions appeared first on Pharmacy Update Online.

Pharmacy technicians are involved at every point in a medicine’s journey, yet they are rarely involved in research. At the Pharmacy Research Showcase, Panayiotis Sphikas, Head of Pharmacy Operations at University College London Hospitals (UCLH) and himself a pharmacy technician, and Dr Yogini Jani, Director of CMORE, the Centre for Medicines Optimisation Research and Education, explained how UCLH set out to change that.

Many technicians reach their roles through vocational rather than university routes, so research can feel like a mystery. When they hear about it, their first thought is often that it is not for them, explained Mr Sphikas. Fear of getting involved, a lack of time, imposter syndrome and few relatable role models all add to the problem, he said.

Evaluation by the people doing the work

The turning point, said Dr Jani, was the trust’s pharmacy strategy. She and Mr Sphikas jointly lead its research and innovation pillar, which helped them build research into everyday work.

When UCLH took on new pre-registration pharmacy technicians, Mr Sphikas set a challenge. He did not want CMORE to evaluate the new programme itself. Instead, he wanted the trainees to be taught to carry out the evaluation, so that the people delivering the service would also evaluate it.

CMORE, now ten years old, provided the infrastructure. Dr Jani met the two trainees every week for one-to-one mentoring and supervision, showing them how to set and refine objectives and what data collection tools look like. A research assistant worked alongside them, giving them a peer to learn from as they collected data and later shared their findings.

Research demystified

The results have been striking. UCLH pharmacy technicians have presented posters at national and international conferences, including the European Association of Hospital Pharmacists congress and the Health Services Research and Pharmacy Practice conference. They are leading an evaluation of an enhanced clinical technician programme funded by NHS England.

The team also visits schools, works with T-level students and employs young people leaving care, and is now evaluating that work too. None of this would have been possible, Mr Sphikas said, without the research mindset the team now has.

“We’ve been successful with two of our pharmacy technicians on the RISE programme” and further NIHR applications are pending, he said. Other organisations now ask UCLH for help, and the team is supporting a pharmacy technician who runs a hypertension clinic outside the trust. In short, said Mr Sphikas, research has been demystified and technicians can now see more, be more and do more in research.

Lessons for others

Dr Jani closed with three lessons. The first was joint leadership. As CMORE’s director, she said, she had to listen to her operational co-lead.

The second was that turning interest into engagement means letting people do the work themselves, rather than doing it for them or to them.

The third was protected time. Mr Sphikas released two pre-registration trainees for one day a week for a year. Without that commitment, she said, their work would never have reached a European stage. For pharmacy teams elsewhere, the message is that technicians can lead research when leaders give them the time, support and permission to do so.

Pharmacy Research Showcase

The Pharmacy Research Showcase was a one-day event organised by the NIHR-Supported Incubator for Pharmacy Professionals which brought together policy-makers and researchers to share experiences and insights. It was held on 22^nd October 2026 at the Royal College of Pharmacy headquarters in London.

Image: Dr Yogini Jani and Mr Panayiotis Sphikas

The post Pharmacy technician-led research appeared first on Pharmacy Update Online.

Digital medicines decisions are often made without good evidence, and pharmacy researchers could help fill that gap. That was the challenge Rahul Singal, Chief Pharmacy and Medicines Information Officer at NHS England, set out at the Pharmacy Research Showcase.

Dr Singal, who leads NHS England’s Digital Medicines Programme, reflected that technology teams rely heavily on user research and service design. Designers may speak to 20 people in depth, then make a decision for the whole population. Academic research could provide a better balance, he suggested, but the two worlds work at different speeds. Technology teams want results in weeks, while researchers need time to think. Aligning the two is the challenge.

Six national priorities

The Digital Medicines programme has six broad aims:

• A single national prescribing and dispensing network built on the Electronic Prescription Service (EPS),
• A single patient medicines’ record accessible by both patients and clinicians, across all care settings
• Traceable medicines information made possible by closing gaps through interoperability, barcode technology and automation
• Digital tools that let patients order, track and manage their own medicines,
• Consistent data foundations,
• Better medicines management in adult social care.

Dr Singal called manual rekeying of medicines information “the biggest patient safety risk and productivity problem”. Future developments should enable seamless transfer of medicines information from one sector to another.

A blueprint for success

In the ideal future, there will be electronic prescribing everywhere, a single national formulary that is embedded into prescribing systems, a modern, secure Electronic Prescription Service (EPS) and a consolidated record for medicines information, he said.

Research questions

NHS England has asked Dr Yogini Jani and Professor Bryony Dean Franklin and their teams to set priorities for digital medication safety research. Ahead of that, Dr Singal shared the questions on his own mind.

On patient enablement, further research into improving adherence is needed. On the new medicines record, he asked what information clinicians need to see before it is trusted and users no longer feel the need to check elsewhere first.

On AI decision support, he raised the risk of “cognitive surrender”- where practitioners no longer think for themselves but unquestioningly accept AI-generated answers. AI might raise the standard of weaker decisions, but where does it become unsafe, and what training do clinicians need, he asked.

Pharmacy Research Showcase

The Pharmacy Research Showcase was a one-day event organised by the NIHR-Supported Incubator for Pharmacy Professionals which brought together policy-makers and researchers to share experiences and insights. It was held on 22^nd October 2026 at the Royal College of Pharmacy headquarters in London.

Image: Dr Rahul Singal

The post Pharmacy research in digital innovations appeared first on Pharmacy Update Online.

How can a trust make research a normal part of pharmacy work rather than an optional extra? Jatinder Harchowal MBE, Chief Pharmacist and Divisional Clinical Director at University College London Hospitals (UCLH), answered that question at the Pharmacy Research Showcase with lessons from almost ten years of practice.

Research has run through his own career, from his first published paper as a renal pharmacist in the 1990s to acting as principal investigator on a large study. At UCLH, one of the country’s largest research organisations, every member of staff is expected to take part in research in some form. That sounds easy, he admitted, but it is not. Leaders have to set the tone and then make the space for staff to do it.

A dedicated centre and aligned strategy

Central to UCLH’s approach is CMORE, the Centre for Medicines Optimisation Research and Education. It was set up in 2017 by its director, Dr Yogini Jani, as a partnership between UCLH and the UCL School of Pharmacy. Its aim is to make research training accessible to all pharmacy staff, with mentoring, supervision and help with grant bids at every stage.

What began as a local collaboration has become a “well-worked system”. Over almost a decade it has supported more than 17 fellowships, more than 19 awards and prizes, over 200 publications and more than 110 national and international conference presentations.

Mr Harchowal stressed the value of aligned strategies. One of the six pillars of the pharmacy and medicines optimisation strategy is about using evaluation, research and advanced analytics to improve care. The trust’s new five-year strategy also includes a pillar on fully integrating research across all healthcare professions. When aims line up like this, he said, it is clear to everyone that research matters.

Three routes into research

He gave three examples to illustrate how research has been built into the day-to-day working of the pharmacy service. First, UCLH ran the first NIHR undergraduate internship at the trust. A UCL pharmacy student and a King’s College London nursing student studied the information given to thoracic surgery patients discharged on opioids. They learned to frame questions, carry out research and publish, and went on to present at conferences.

Second, the pharmacist-led hypertension clinic built evaluation into an existing service from the start. Six pharmacists now review patients and evaluate the service at the same time, showing that research does not always need extra protected time.

Third, and most successful, was the research-active pharmacy technician programme. When the trust funded 16 pre-registration technician posts, the team designed the roles from the outset to include structured, publishable research. The technicians now present nationally and internationally and have won NIHR funding. They have probably set the bar for many pharmacists, he said.

Lessons for other trusts

Mr Harchowal’s advice was to give staff permission and visible support from the top, and then to make the time. Building research into objectives and providing training and tools helps make it part of the daily job.

He urged teams to celebrate success. UCLH’s Festival of Excellence, now in its fourth year, accepted 96 pieces of multidisciplinary work this year, he said. He also encouraged visits to other organisations, crediting colleagues in Northumbria for shaping UCLH’s approach.

He ended with a warning. Other professions are “pushing the doors as much as we are“, moving into research quickly, and if pharmacy does not step up, others will fill that space.

Pharmacy Research Showcase

The Pharmacy Research Showcase was a one-day event organised by the NIHR-Supported Incubator for Pharmacy Professionals which brought together policy-makers and researchers to share experiences and insights. It was held on 22^nd October 2026 at the Royal College of Pharmacy headquarters in London.

Image: Jatinder Harchowal

The post Making research part of routine pharmacy work appeared first on Pharmacy Update Online.