Editorial: Pharmacists and patient safety: focusing on drug safety

Patient safety is defined as "the absence of preventable harm to a patient and reduction of risk of unnecessary harm associated with health care to an acceptable minimum" by the World Health Organization [1] . Approximately 50% of medical harm worldwide occurs in primary care settings, of which about 80% can be effectively prevented through primary care services [2] . Medication-related harm is considered preventable if it occurs as a result of an identifiable, modifiable cause and its recurrence can be avoided by appropriate adaptation to a process or adherence to guidelines [3] .Understanding the prevalence, nature and severity of preventable medication-related harm is critical for setting targets for clinically relevant, implementable improvements in patient safety [4,5] . To meet this challenge, the role of the pharmacist is undergoing a fundamental paradigm shift: transitioning from a traditional "drug supplier" to a "health guardian" deeply involved in clinical decision-making [6] . This topic aims to focus on patient safety by utilizing professional interventions, technological innovation, and evidence-based medicine to achieve precise prevention and control of medication risks and optimization of clinical outcomes.Most general practitioners believe that pharmacists possess the clinical skills necessary to provide safe and effective care to patients [7] The professional value of pharmacists is increasingly prominent in intensive care and complex treatments [8] . The use of immune checkpoint inhibitors (ICI) has led to adverse reactions, including a significantly increased risk of tuberculosis (TB) infection and drug-class-specific digestive system inflammatory reactions. A real-world observational study by Mei Zhan et al. analyzed 8,199 cancer patients treated with ICIs; the incidence of TB after treatment was 1.96%, significantly higher than that of the general population. The study emphasizes that in areas with a high burden of TB, systematic TB screening should be conducted before starting ICI therapy. Ya Zou et al.Analysis of the FDA Adverse Event Reporting System database and a systematic review revealed class-specific digestive toxicities for ICIs. PD-1 inhibitors are most strongly associated with inflammation of the upper gastrointestinal tract (esophagitis, gastritis) and hepatobiliary system (hepatitis, cholangitis), while CTLA-4 inhibitors (such as ipilimumab) show stronger signals for enterocolitis/colitis. These findings assist clinicians in personalized risk assessment and monitoring.Pediatric patient groups vary widely in age, body size, and developmental stage, particularly those in pediatric intensive care who present with various underlying diseases accompanied by changes in organ function [9] . A study by Min Qin et al.analyzed cases of acute kidney injury (AKI) caused by vancomycin in a pediatric intensive care unit (PICU). The results showed that off-label high-dose use (>40 mg/kg/day) is closely related to the risk of renal injury. By implementing therapeutic drug monitoring (TDM) and Bayesian individualized dosing regimens, the AKI incidence rate dropped to zero, and the monitoring rate increased from 53.8% to 88.4%. The use of advanced technical means to process real-world data provides smarter assistance for clinical practice [10] . ChangLi He et al. demonstrated how prediction technology can shift from "post-event alertness" to "pre-event prevention". This study utilized machine learning to establish a venous thromboembolism (VTE) risk prediction model for lymphoma patients. The optimal simplified model includes nine key predictors, among which venous catheterization, D-dimer, and lactate dehydrogenase WeChat public accounts. The study found that the five topics the public is most concerned about are: drug dosage, side effects, children's infections, the efficacy of traditional Chinese medicine, and administration routes. Public interest is shifting from "side effects" to practical "medication issues," providing creative guidance for the transformation of pharmacy professionals.Pharmacists assess the merits of treatment regimens from scientific and economic perspectives [11] Patients significantly preferred subcutaneous administration (OR 63.02), primarily because it is more convenient and saves time. Cost analysis showed that the SC regimen has a cost advantage under the Chinese healthcare system. Gilberto Uriel Rosas Sánchez et al. argued that generic drugs are key tools for solving the mental health crisis and reducing treatment costs. Generics are bioequivalent to original drugs but are typically more than 80% cheaper. The article pointed out that overcoming the psychological bias of doctors and patients toward the quality of generic drugs (such as the nocebo effect) is crucial for improving treatment adherence and health equity.Fengjiao Kang et al. compared second-line therapies for advanced liver cancer through a network meta-analysis, identifying the drug regimens that achieved the best balance between efficacy and tolerance. The results showed that Pembrolizumab and Ramucirumab achieved the best balance between efficacy and safety (lower incidence of Grade 3 or higher adverse reactions). Apatinib and Cabozantinib performed excellently in progression-free survival (PFS), but their toxicity was relatively high.The themes of this issue collectively constitute a comprehensive map of medication safety management: from the macro transformation of pharmaceutical care models to the micro-optimization of individualized medication regimens; from cuttingedge machine learning predictions to basic clinical evidence quality control. The ultimate goal is to build a safer, more efficient, and more socially equitable medical environment.