Background: Medication nonadherence in heart transplant recipients (HTxR) is related to graft loss and death. mHeart is a mobile app that uses electronic patient-reported outcome measures (ePROMs) to identify and manage medication nonadherence in the outpatient heart transplant (HTx) population. Objective: The study primarily aimed to validate mHeart to measure medication nonadherence in early stage HTxR by assessing the psychometric properties of ePROMs. The secondary aims were to (1) measure patient satisfaction with the mHeart tool and its usability and (2) explore the impact of a theory-based treatment on medication nonadherence rates to determine its scalability to larger research. Methods: A prospective study was conducted in the outpatient clinic of a tertiary hospital. All consecutive early stage HTxR (<1.5 years from HTx) were included. The ePROM psychometric properties assessed were validity, reliability, responsiveness, interpretability, and burden. ePROMs comprised the 4-item Morisky-Green-Levine questionnaire and an adapted version of the Haynes-Sackett questionnaire. The Simplified Medication Adherence Questionnaire (SMAQ) was also applied on-site. Three consecutive medication nonadherence assessments were performed by a transplant pharmacist. To improve medication nonadherence, theory-based interventions were delivered in a 1-month period. Patient satisfaction was assessed by a semiquantitative Web-based survey at the end of the study. Results: We included 31 early stage HTxR (age: mean 54 years, SD 12 years), and 71% (22/31) of them were men. The HTxR were taking a mean 13 (SD 4; range 7-18) drugs per day. A total of 42% (13/31) of patients were unaware of the consequences of medication nonadherence, and 39% (12/31) of patients were nonadherent to immunosuppressive treatment. The content validity measure showed excellent levels of expert panel agreement for the Haynes-Sacket (14/14, 100%) and Morisky-Green-Levine (13/14, 93%) questionnaires. SMAQ and Morisky-Green-Levine ePROMs showed similar measurement domains (convergent validity, phi=0.6, P<.001), which, as expected, differed from Haynes-Sackett ePROMs (divergent validity, phi=0.3, P=.12). Reliability assessment revealed a very strong association between ePROM and on-site PROMs (phi>0.7, P<.001). Reproducibility was moderate (Haynes-Sackett κ=0.6, P<.002) or poor (Morisky-Green-Levine κ=0.3, P=.11) because of unexpected improved medication adherence rates during the test-retest period. According to responsiveness, the theory-based multifaceted intervention program improved medication nonadherence by 16% to 26% (P<.05). A burden analysis showed that ePROMs could potentially overcome traditional on-site limitations (eg, automatic recording of ePROM responses in the hospital information system). The mean score for overall patient satisfaction with the mHeart approach was 9 (SD 2; score range: 0-10). All 100% (29/29) of patients surveyed reported that they would recommend the mHeart platform to other HTxR. Conclusions: ePROMs adhered to the quality standards and successfully identified medication nonadherence in the HTx population, supporting their widespread use. The theory-based intervention program showed a promising improvement in medication adherence rates and produced excellent patient satisfaction and usability scores in HTxR.

BACKGROUND Adherence problems, interactions and higher rate of risk activities have been observed in HIV individuals using recreational drugs. Our aim was to describe recreational drug use in both HIV individuals and general population in Europe, and to assess at what extent HIV guidelines address this issue. METHODS Data on recreational drug use across Europe were obtained from the European Monitoring Centre for Drugs and Drug Addiction for the general population, and through Pubmed search. for HIV patients. We assessed the incorporation of recreational drug issues in HIV treatment guidelines for the following topics: a) recreational drugs; b) adherence to antiretrovirals; c) interactions; d) transmission risk. Guidelines included: World Health Organization; European Aids Clinical Society; U.S. Department of Health and Human Services; International Antiviral Society-USA; and seven European national guidelines. RESULTS 29 countries reported recreational drug use in general population. The highest prevalences were observed for Cannabis (i.e. 8-10% in Spain, France and Czech Republic) followed by cocaine, amphetamines and ecstasy. The 13 studies selected in the systematic review showed a great variability in recreational drug use on the HIV population. Apart from classical recreational drugs, we found a relevant use of new drugs including sexual experience enhancers. Polydrug consumption was about 50% in some studies. Most guidelines included general information about recreational drugs, showing great variability on the inclusion of the evaluated topics. We found more specific, evidence-based recommendations on interactions, followed by medication adherence and transmission risk. CONCLUSIONS Available data on the people living with HIV suggest a higher use of recreational drugs than in the general population, which is already relevant. However, recreational drug issues should be included or addressed more thoroughly in most guidelines.

Ceftolozane-tazobactam (CT) is used for the treatment of complicated infections and for multidrug-resistant strains of Pseudomonas aeruginosa and extended-spectrum beta-lactamase-producing enterobacteria. In certain cases, simultaneous administration of CT and parenteral nutrition (PN) may be required, but compatibility of Y-site co-administration is unknown. The aim of this study was to analyse the physicochemical compatibility of CT Y-site administered with PN. We evaluated a protocolized PN approach for critical patients in our center. We studied both bolus infusion (2 g ceftolozane/1 g tazobactam in 1 h) and continuous infusion (CI) (6 g ceftolozane/3 g tazobactam) strategies. Samples were visually observed against light, microscopically inspected, and pH was analysed using a pH meter. The mean lipid droplet diameter (MDD) was determined via dynamic light scattering. CT concentration was quantified using HPLC–HRMS. No alterations were observed through visual or microscopic inspection. Changes in pH were ≤0.2, and changes in osmolarity were less than 5%. MDD remained below 500 nm (284.5 ± 2.1 for bolus CT and 286.8 ± 7.5 for CI CT). CT concentrations at t = 0 h and t = 24 h remained within prespecified parameters in both infusion strategies. CT is physiochemically compatible with PN during simulated Y-site administration at the tested concentration and infusion rates.

Objective: The objective of this study is to compare the effectiveness of reference biologic medicines used in the treatment of rheumatoid arthritis (RA) specifically adalimumab, etanercept, and infliximab, with corresponding biosimilar medicines, based on an exploratory analysis of clinical data obtained in patients treated with these medicines in five hospitals in the region of Catalonia, Spain. Methods: There is a consultation of the database of the Registry of Patients and Treatments of the Catalan Health Service: extraction of data from adult patients diagnosed with moderate and severe active RA and with active prescription of at least one biological drug (reference or biosimilar) or JAK inhibitor. To compare the effectiveness of each reference biologic with its biosimilar, differences in mean DAS28-ESR values before and after treatment were assessed for adalimumab and its biosimilar, etanercept and its biosimilar, and infliximab and its biosimilar. Results: The study consisted of 643 patients. The most dispensed medicines were anti-TNFs, with 303 patients on treatment. Thirty-six percent of all patients were using biosimilars. No statistically significant differences were observed in any of the three comparisons between the reference biologic medicine and its biosimilar. These findings suggest that biosimilars have comparable effectiveness to reference biologics in reducing DAS28-ESR; in addition, they can provide substantial savings to public health systems. Conclusions: A significant number of patients diagnosed with moderate to severe active RA were treated with biological medicines and receiving the available biosimilar treatments. Future research should be conducted to confirm comparable effectiveness found to their reference biologic medicines in this exploratory analysis. Key Points• Biosimilar use: 36% of rheumatoid arthritis (RA) patients in Catalonia are treated with biosimilars, exceeding the 12% recommendation. This reflects growing acceptance of these alternatives.• Comparative effectiveness: Biosimilars of adalimumab, etanercept, and infliximab showed comparable therapeutic benefit to their reference biologics in reducing disease activity in active rheumatoid arthritis.• Real-world data: The study provides real-world data from five hospitals, making biosimilar medicines a viable choice for rheumatologists in routine rheumatoid arthritis management.

Background: Board of Pharmacy Specialties certification has emerged internationally as a mechanism to support advanced pharmacy practice and professional differentiation. However, little is known about how BPS‐certified pharmacists perceive its value within health care systems with specialist training pathways, such as in Spain. This study aimed to explore the perceived value, professional impact, and implementation barriers of BPS certification among hospital pharmacists in Spain. Methods: A qualitative descriptive study used semi‐structured interviews with BPS‐certified hospital pharmacists practicing in Spain. Participants were purposively recruited to ensure diversity in certification specialty, geographical region, and profile. Interviews were conducted between April and June 2026, audio‐recorded, transcribed, and analyzed using qualitative content analysis. Reporting followed Consolidated Criteria for Reporting Qualitative Research. Results: Eleven hospital pharmacists representing multiple BPS specialties participated. Participants perceived BPS certification as strengthening clinical competence, improving confidence in pharmacotherapeutic decision‐making, and supporting advanced clinical practice. Certification was perceived to enhance professional credibility within interprofessional clinical teams and among pharmacist colleagues. However, participants described limited institutional recognition, with little impact on salary, career progression, employment systems, or protected professional development time. Major barriers included time investment, economic costs, recertification requirements, and partial mismatch between the United States–oriented examination framework and the Spanish health care context. Participants viewed BPS certification as a complementary credential to the national hospital pharmacy residency system rather than a substitute for specialist training. Most anticipated demand for credentialing would continue to increase as hospital pharmacy practice becomes specialized and clinically complex. Conclusions: BPS certification is perceived as a valuable mechanism supporting advanced clinical competence, professional differentiation, and integration into interprofessional practice. Nevertheless, broader implementation remains limited by insufficient institutional recognition and structural support. Greater alignment between international credentialing systems and national professional development frameworks may facilitate integration of pharmacy practice credentials within the Spanish health care system.