A systematic review and pooled prevalence of burnout in pharmacists.

BACKGROUND: Burnout is an occupational phenomenon caused by ineffectively managed work-related stress. Burnout is common among healthcare professionals and has the capacity to compromise patient care, but is not well characterised in pharmacists. AIM: This systematic review aimed to establish the prevalence of burnout among pharmacists, and its associated risk factors. METHOD: A systematic search of Embase, PubMed, CINAHL and PsychInfo was carried out. Studies were included using the following eligibility criteria; original research investigating burnout prevalence in pharmacists in patient-facing roles in any jurisdiction, using any validated burnout measurement instrument. No language or date barriers were set. Data were extracted by the first author and accuracy checked by co-authors. A pooled prevalence was estimated, and narrative synthesis provided. RESULTS: Burnout prevalence data were extracted from 19 articles involving 11,306 pharmacist participants across eight countries. More than half (51%) of pharmacists were experiencing burnout. Associated risk factors included longer working hours, less professional experience, high patient and prescription volumes, excessive workload and poor work/life balance. The COVID-19 pandemic has negatively impacted pharmacist burnout and resilience. Involvement in education and training and access to burnout management resources were associated with lower rates of burnout, but burnout intervention effectiveness is unknown. CONCLUSION: Burnout remains high among pharmacists and may negatively affect the quality of patient care. There is significant heterogeneity pertaining to the definition and assessment of burnout and there remains a need to identify and evaluate effective individual and organisational burnout interventions.

A randomized, double-blind, placebo-controlled trial of intravenous alpha-1 antitrypsin for ARDS secondary to COVID-19.

Background: Patients with severe coronavirus disease 2019 (COVID-19) develop a febrile pro-inflammatory cytokinemia with accelerated progression to acute respiratory distress syndrome (ARDS). Here we report the results of a phase 2, multicenter, randomized, double-blind, placebo-controlled trial of intravenous (IV) plasma-purified alpha-1 antitrypsin (AAT) for moderate to severe ARDS secondary to COVID-19 (EudraCT 2020-001391-15). Methods: Patients (n = 36) were randomized to receive weekly placebo, weekly AAT (Prolastin, Grifols, S.A.; 120 mg/kg), or AAT once followed by weekly placebo. The primary endpoint was the change in plasma interleukin (IL)-6 concentration at 1 week. In addition to assessing safety and tolerability, changes in plasma levels of IL-1ß, IL-8, IL-10, and soluble tumor necrosis factor receptor 1 (sTNFR1) and clinical outcomes were assessed as secondary endpoints. Findings: Treatment with IV AAT resulted in decreased inflammation and was safe and well tolerated. The study met its primary endpoint, with decreased circulating IL-6 concentrations at 1 week in the treatment group. This was in contrast to the placebo group, where IL-6 was increased. Similarly, plasma sTNFR1 was substantially decreased in the treatment group while remaining unchanged in patients receiving placebo. IV AAT did not definitively reduce levels of IL-1ß, IL-8, and IL-10. No difference in mortality or ventilator-free days was observed between groups, although a trend toward decreased time on ventilator was observed in AAT-treated patients. Conclusions: In patients with COVID-19 and moderate to severe ARDS, treatment with IV AAT was safe, feasible, and biochemically efficacious. The data support progression to a phase 3 trial and prompt further investigation of AAT as an anti-inflammatory therapeutic. Funding: ECSA-2020-009; Elaine Galwey Research Bursary.

Educating pharmacy students through a pandemic: Reflecting on our COVID-19 experience.

The impact of the COVID-19 pandemic on pharmacy education worldwide has been immense, affecting students, educators and regulatory agencies. Pharmacy programmes have had to rapidly adapt in their delivery of education, maintaining standards while also ensuring the safety of all stakeholders. In this commentary, we describe the challenges, compromises and solutions adopted by our institution throughout the pandemic, the lessons learnt, adaptive measures taken, and strategies to develop and future-proof our curricula.

The challenges of COVID-19 for community pharmacists and opportunities for the future

Pharmacists, like psychiatrists, have modified their practices amidst COVID-19 in order to guarantee care and support to their patients. Designated an essential frontline service, community pharmacists are facing a spectrum of challenges to surmount to ensure patient care continues. These include assisting in the prevention of infection, managing supply chains, preventing stockpiling and provision of evidence-based medical information. However, disasters like COVID-19 disproportionately affect poor and vulnerable populations, and patients with mental health conditions may be among the hardest hit. Pharmacist-level, system-level and regulatory responses have sought to minimise this impact, although there is likely to be a lasting impression on the profession, both good and bad. This article reviews the pandemic-related challenges and responses by pharmacists, as well as forming recommendation for areas of professional support and role expansion, particularly in the case of mental health.