Artificial intelligence (AI) has shown substantial potential to improve patient outcomes in parenteral nutrition by enabling individualised nutritional strategies, early prediction of metabolic and infectious complications, and optimised real-time clinical decision-making. Evidence from global clinical practice demonstrates that AI integration can enhance patient safety, reduce complication rates, and improve resource utilisation. In Bulgaria, recent developments in parenteral nutrition reflect progress toward standardisation, wider availability of modern formulations, and alignment with international clinical guidelines. However, the adoption of AI-driven systems for personalised nutrition planning and continuous risk assessment remains limited. Key barriers include the availability and quality of clinical data, regulatory and ethical considerations, and the need for targeted training of healthcare professionals. This review highlights both the opportunities and challenges associated with implementing AI in parenteral nutrition in the Bulgarian context. Potential benefits include improved patient outcomes, shorter hospital stays, more efficient healthcare delivery, and alignment with international best practices. At the same time, overcoming infrastructural, regulatory, and educational barriers is essential for successful implementation. Conclusions: The integration of AI into parenteral nutrition requires a multidisciplinary approach that combines clinical expertise, technological innovation, and supportive health policy. Such an approach offers the potential to sustainably enhance patient care in Bulgaria and position national practice in line with leading global standards.

Introduction: Work in the field of healthcare is accompanied by considerable emotional tension. Pharmacists are at risk of professional burnout, but so far, there is very little scientific research in this professional group in Bulgaria. Objective: To study the presence of Burnout Syndrome among Bulgarian pharmacists and perform an analysis according to the demographic characteristics of respondents. Material and Methods: A pilot study was conducted for the presence of Burnout Syndrome among 142 pharmacists in Varna, Bulgaria, working in different areas of the pharmaceutical sector: pharmacies for public services, hospital pharmacies, pharmaceutical companies, higher education institution. The information was collected using an anonymous questionnaire that included the specialized Maslach Burnout Inventory (MBI) tool to examine professional burnout according to three subscales: emotional exhaustion, depersonalisation and personal accomplishment. Results: Higher levels of emotional exhaustion and depersonalisation were found in male respondents in comparison to women, while the values between the two genders were almost similar according to the professional achievement subscale. The most vulnerable group was the male group at the age of 31-40. Pharmacists over the age of 50 had lower levels of burnout as they had developed good habits to deal with stress. Conclusion: Gaining professional experience in pharmacists is associated with an increase in the levels of professional burnout. High levels of depersonalisation are a prerequisite for worse quality of pharmaceutical care.

Background: Burnout is described as an emotional, mental and physical exhaustion observed in healthy people and directly related to their professional context. The objective is to study the level of burnout among community pharmacists and to identify the workplace factors affecting it. Materials and methods: Using a questionnaire, specifically designed by the authors of the study, an anonymous survey was conducted in the region of Varna, as the largest region of Northeastern Bulgaria. The questionnaire contains questions about the demographic characteristics; a standardised burnout measure tool (MBI-HSS-MP), and questions regarding the specifics of the work environment. According to MBI-HSS-MP, burnout is associated with high levels of emotional exhaustion (EE) and depersonalisation (DP) and low level of personal accomplishment (PA). Results: The participants in the pilot study were 127 masters of pharmacy. Regarding individual factors, a statistically significant relationship was found between age and the scales emotional exhaustion EE (p = 0.012), depersonalisation DP (0.028) and personal accomplishment PA (p = 0.028). Most susceptible to ЕЕ (p = 0.014) and DP (p = 0.008) were the age group 25–45 years while most satisfied with their PA were in the age group 46–55 years (p = 0.016). From the organisational factors, the large number of patients had the greatest impact on burnout (DP р = 0.000 /ЕЕ р = 0.006). The other key factors for burnout were an insufficient number of pharmacy staff, a heavy administrative burden and a wide range of medicinal products. Conclusion: It is necessary to develop training courses for young professionals to introduce them gradually into the work process and build up skills for effectively coping with stress. Proposals need to be made for reducing the administrative burden of pharmacists and maintaining staffing levels that are adequate to the patient flow and expanding the capabilities of The Specialised Electronic System for Tracing and Analysis System of Medicinal Products (SETASMP).

Introduction: The disorder known as burnout develops as a reaction to the damaging impacts of workplace stress. When occupational stress is poorly managed, it can result in burnout, which has a detrimental impact on workers’ performance and emotional and physical well-being. Those who work in the helping profession are the most vulnerable. Pharmacy practitioners are among the most vulnerable groups in the healthcare industry. Aim: The aim of the study was to look into how community pharmacists’ work environments affect their levels of occupational burnout. Materials and methods: The current survey included 127 pharmacists holders of a Master of Pharmacy degree who practice in Bulgaria’s northeast. A paper-based questionnaire with details about the workplace of these pharmacists and the Maslach Burnout Inventory (MBI-HSS-MP), a validated assessment instrument, were used to conduct the survey. Results: The majority of those surveyed (53%) had a medium to high degree of burnout at work. The highest percentage of pharmacists (51%) received high scores on the depersonalization scale, which is associated with a lack of motivation for providing patient care. The degree of burnout was found to be unaffected by the kind of community pharmacy – chain or individually owned. Burnout was more prevalent among responsible and non-responsible pharmacists than among pharmacy owners. Conclusion: It was determined that pharmacists needed training and preventative measures to avoid occupational burnout, even though there was no evidence of a statistically significant relationship between the job position and burnout.

Medical professionals are the most susceptible to professional burnout. An anonymous survey of master pharmacists was conducted to assess burnout with the MBI-HSS-MP tool and analyse the challenges of working in community pharmacies. Burnout affected 53% of the 127 pharmacists surveyed. Factors influencing the scales forming burnout emotional exhaustion (EE) depersonalisation (DP), and personal accomplishment (PA) were: administrative difficulties in servicing the prescriptions of chronically ill patients: affected 57% of respondents and influenced EE (p = 0.036); lack of precise instructions at work (38% of respondents, influenced DP, p = 0.007) and (EE, p = 0.000); lack of prior information about innovations 38% (EE p = 0.002). Lack of time to carry out pharmaceutical care (PhC) influenced EE (p = 0.019) and DP (p = 0.006) and DP was associated with lower empathy for patients, Lack of perceived professional satisfaction (PA; p = 0.042) was increased. The increased administrative duties shifted the focus away from PhC and decreased pharmacists’ motivation.

The common border between Bulgaria and North Macedonia, alongside the regulatory requirements stemming from Bulgaria’s membership in the European Union, provide grounds for comparing the legislative environment in both countries. This article presents a comparative case study of the regulatory frameworks governing community pharmacies in Bulgaria and North Macedonia. The aim of this study is to examine the specific features of current legislation related to the operation of community pharmacies, and to identify similarities, differences, and gaps in the organizational structure of pharmacy services, the population’s access to pharmaceutical care, and the qualification requirements for personnel working in community pharmacies. Bulgaria has been a member of the European Union since 2007, while the Republic of North Macedonia has had official EU candidate status since 2005. This provides a basis for comparing the regulatory frameworks of an EU and a non-EU system within the same regional context. In both countries, the overall pharmacy-to-population ratio exceeds the European average (3.3 pharmacies per 10,000 inhabitants), indicating sufficient availability. However, pharmacies are predominantly concentrated in major urban areas. In Bulgaria, challenges remain in ensuring access to pharmaceutical services in smaller and rural settlements, while in North Macedonia, the provision of such services is better ensured. The findings of this case study may be particularly relevant for countries undergoing health system reforms or EU harmonization processes.