Perceptions and Attitudes of Hospital' Prescribers towards Drug Information Sources and Prescribing Practices

Abstract Healthcare professionals use a variety of drug information sources to fulfill their clinical needs and medical practice. The aim of present study was to assess the sources of drug information among hospital' prescribers and evaluate their prescribing behavior in Saudi hospitals. A cross-sectional survey was conducted among randomly selected hospital' prescribers using a self-administered questionnaire. The response rate to the survey was 64.29%, with a ratio of 76.44% male and 23.56% female. The internet 137(60.89%) and textbooks 86(38.22%) were the prevalent sources for drug information used. Up-To-Date 107(47.56%), Medscape 105(46.67%) and FDA 74(32.88%) were the common electronic drug sources used. About 151(67.11%) of hospital' prescribers considered the pharmacist as a reliable drug information source. The most favored drug requests by hospital' prescribers from the pharmacists were drug alternatives 110(48.89%) followed by drug interactions 94(41.78%), side effects 78(34.67%) and indications 60(26.67%). Therapeutic efficacy 168(74.67%) and drug availability 73(32.44%) were the main factors contributed to the selection of drugs. This study shows some differences in hospital prescribers' perceptions of sources of drug information depending upon their background and clinical practice. Therefore, knowing appropriate drug information used by hospital' prescribers is fundamental for drug efficacy and safety in clinical practice.

Drugs, pesticides and metabolites in forensic post-mortem blood samples.

Forensic post-mortem toxicological data provide valuable information for the elucidation of cause of death. However, this is still not routine practice in Brazilian laboratories. This study investigated the presence of illicit and prescription drugs, pesticides and metabolites in 111 post-mortem blood samples from cases investigated by the Forensic Medical Institute of the Federal District, Brazil. Quantitative analysis was performed for 14 analytes using a validated programmed temperature vaporisation-large volume injection-gas chromatography-mass spectrometry method, which was also used as screening (qualitative analysis) for an additional 19 substances of forensic interest. At least one analyte was found in 61.2% of the samples, of which 34 were related to homicide, 15 to accidental death and 10 to suicide cases. The victims were 14-72 years old. The benzodiazepines diazepam, midazolam and 7-aminoflunitrazepan were detected in 46% of the positive samples (0.02-1.12 µg/mL; midazolam only qualitative). Cocaine was found in 34% (0.02-4.07 µg/mL), associated with substances commonly used as cocaine adulterants (e.g. caffeine, lidocaine and phenacetin). Three suicide cases involved the illegal rodenticide chumbinho, residues of which were found in the gastric content, and blood samples showed the presence of terbufos (0.03 and 0.04 µg/mL) and carbofuran (27.3 µg/mL). These results are discussed, along with autopsy and crime-scene information.

Prevalence of xenobiotic substances in first-trimester blood samples from Danish pregnant women: a cross-sectional study.

OBJECTIVE: The aim of this study was to investigate the prevalence of xenobiotic substances, such as caffeine, nicotine and illicit drugs (eg, cannabis and cocaine), in blood samples from first-trimester Danish pregnant women unaware of the screening. DESIGN: A cross-sectional study examined 436 anonymised residual blood samples obtained during 2014 as part of the nationwide prenatal first-trimester screening programme. The samples were analysed by ultra performance liquid chromatography with high-resolution time-of-flight mass spectrometry. SETTING: An antenatal clinic in a Danish city with 62 000 inhabitants, where >95% of pregnant women joined the screening programme. PRIMARY AND SECONDARY OUTCOME MEASURES: The prevalence and patterns of caffeine, nicotine, medication and illicit drug intake during the first trimester of pregnancy. RESULTS: The prevalence of prescription and over-the-counter drug detection was 17.9%, including acetaminophen (8.9%) and antidepressants (3.0%), of which citalopram (0.9%) was the most frequent. The prevalence of illegal drugs, indicators of smoking (nicotine/cotinine) and caffeine was 0.9%, 9.9%, and 76.4%, respectively. Only 17.4% of women had no substance identified in their sample. CONCLUSIONS: This study emphasises the need for further translational studies investigating lifestyle habits during pregnancy, as well as the underlying molecular mechanisms through which xenobiotic substances may affect placental function and fetal development.

Renovação de Prescrição Médica na atenção primária: uma análise crítica / Prescription refill in primary health care: a critical analysis

A renovação de receita é uma prática comum nos serviços de atenção básica no Brasil, ainda que pouco discutida. Embora exista um número expressivo de artigos em língua inglesa sobre o assunto, pouco se encontra a respeito na literatura brasileira. A renovação de medicamentos de uso contínuo traz consigo riscos e potenciais danos à saúde do usuário quando praticada sem protocolos bem definidos e sem a correta avaliação clínica das pessoas acompanhadas. Dessa forma, a renovação de receita pode perpetuar o uso de medicações com indicação duvidosa, efeitos colaterais significativos, interações medicamentosas importantes, medicamentos contraindicados e/ou que não são mais necessários. Além disso, pode transmitir a sensação de que a população está sendo bem assistida apenas pelo fato de as pessoas conseguirem receber medicamentos, ainda que sem uma avaliação periódica. Por outro lado, caso realizada de forma ideal, poderia favorecer aumento da adesão ao tratamento, bem como a avaliação de interações medicamentosas, o cumprimento da terapêutica e a necessidade de exames complementares. O presente artigo realizará uma discussão crítica sobre os riscos e benefícios da renovação de receita da maneira como é feita no Brasil, incluindo seus aspectos legais e pontos passíveis de melhorias segundo a literatura internacional. (AU)

Repeat prescribing is a common practice at primary health care in Brazil which is poorly discussed. Despite the large number of articles in English, the Brazilian literature barely discuss this subject. The renewal of continuous-use medication may lead to risks and potential harms to patient health when used without defined protocols or adequate clinical evaluation. This practice may perpetuate the use of medication with arguable indication, significant side effects, significant drug interactions, contraindicated drugs or that are no longer needed. It also may leads to a misperception of being well attended, although it is a mere transcription of medical receipts. However, if performed in an adequate way, it might be associated with increased adherence to treatment. It also might allow assessment of drug interactions, compliance with therapy and checking out the need for complementary tests. This article will critically discuss the risks and benefits of prescription renewal in the way it is done in Brazil, including its legal aspects and possible points for improvement according to the international literature. (AU)

Purchase of prescription and OTC medicines in Slovakia: factors influencing patients' expectations and satisfaction

ABSTRACT Slovakia is a country where the purchase of OTC (over the counter) medicines outside the pharmacy is not allowed by the government. This study aimed at evaluating patients' satisfaction and acceptance of community pharmacists. Customer's behaviour and expectations influencing the purchase of prescription and OTC medicines were analyzed. A structured questionnaire having 15 multiple-choice questions was used to analyze the descriptive parameters. Data collection lasted from January to February 2014. The sample size consisted of 357 high-school educated individuals under 40 years of age. The survey showed that the prescription and OTC medicines were bought equally. The participants reported a 96.0%, 96.3% and 90.2% satisfaction rate with willingness and approach of the community pharmacist, pharmacy services and provision of drug information respectively. As for the OTC medicines, 89.5% people considered the pharmacist an expert: 88.2% purchased medicines with pharmacist's recommendation, 97.8% needed a professional counselling and 97.2% required a pharmacist's guidance. As for the prescription drugs, only 72.1% considered the pharmacist an expert: 96.3% suggested that physician's prescription was significant and 88.3% considered pharmacist's guidance in the process of selection of prescription medicines nonessential. A comprehensible and respectable conversation was highly expected in regards to both the OTC and prescription medicines.

Field study to detect illicit and medicinal drugs in car drivers in Southern and Western Hesse.

In the present study, immunochemical tests (Mahsan DrugInspector, DOA4, DOA8, DOA10, Protzek) as well as the detection rate of police checks were evaluated. Urine and blood samples of suspected car drivers were analysed by chromatography-mass spectrometry. Additionally, anonymised urine samples were analysed on a voluntary basis in cases where no legal proceedings were initiated. Toxicological analyses (total unknown screening) were performed using gas chromatography-mass spectrometry (GC-MS) after hydrolysis, acidic and alkaline extraction and derivatization. A data base for screening 9000 substance entries was applied. In addition, urine samples were analysed using liquid chromatography/ time-of-flight mass spectrometry (HPLC-ToF-MS) to screen psychiatric and narcotic drugs. In total, samples of 154 suspects were analysed, of these, 46 samples for no actual reason. In 5 of the latter samples, forensically relevant substances were detected; in two cases the consumption of illicit drugs, i. e. cannabis and methamphetamine, was proved. Of the 154 suspects, 108 were charged with driving under the influence of drugs; in samples of 103 of these cases, illicit drugs were found. Immunochemical pretesting showed posi- tive results in 97 of the 108 cases; in 6 samples, psychiatric drugs (citalopram, doxepin, promethazine, mirtazapine, fluoxetine, venlafaxine) were later identified, which are not detectable by ordinary pretesting systems. Police officers successfully identified 95.4 % of the suspects as drug consumers, which is an excellent result. In practice, pretesting of urine samples using immunochemical techniques proved to be very reliable. The Protzek system in particular corresponded well with the results of the chromatographic analyses. In conclusion, systematic chromatographic-mass spectrometric analysis of urine samples of suspects is recommended to identify car drivers consuming illicit drugs and to obtain data usable in legal proceedings (e. g. suspending of the driving license), which is not always possible when using blood samples in cases of drugs consumed some time ago.

Analysis of endocrine disrupting compounds, pharmaceuticals and personal care products in sewage sludge by gas chromatography-mass spectrometry.

Endocrine disrupting compounds (EDCs) and pharmaceuticals and personal care products (PPCPs) have been acknowledged as emerging pollutants due to widespread contamination in environment. A rapid and reliable analytical method, based on ultrasonic extraction, clean up on Envi-carb cartridge, derivatized with N-tert-butyldimethylsilyl-N-methyltrifluoroacetamide (MTBSTFA), and analyzed by gas chromatography-mass spectrometry (GC-MS), was developed for determination of 4 EDCs (bisphenol A, estrone, nonylphenol and octylphenol) and 10 PPCPs (acetylsalicylic acid, carbamazepine, clofibric acid, diclofenac, gemfibrozil, ibuprofen, ketoprofen, naproxen, paracetamol and triclosan) in sewage sludge. Mean recoveries of the target analytes, at different spike levels (40, 300 and 2000 ng/g), ranged from 57.9% to 103.1%. Relative standard deviations (RSDs) were in the range of 1.3-9.5% at different spiked levels. The limit of quantification (LOQ) ranged from 4.7 to 39 ng/g. The method was applied to sewage sludge samples from sewage treatment plants (STPs) in southern California. High concentrations of PPCPs and EDCs were found in sewage sludge, ranging from 1502 to 5327 ng/g dry weight. Appropriate disposal of sewage sludge was required to avoid secondary contamination.

Wastewater reuse in Mediterranean semi-arid areas: The impact of discharges of tertiary treated sewage on the load of polar micro pollutants in the Llobregat river (NE Spain).

The presence of sewage-borne micro contaminants in environmental waters is directly related to the discharge of treated effluents from wastewater treatment plants (WWTP) and the flow rate of the receiving river waters. Mediterranean rivers, in particular, are characterized by important fluctuations in the flow rates and heavy pollution pressures resulting from extensive urban, industrial and agricultural activities. This translates into contamination levels in these rivers often higher than those in other larger European basins. The present work provides an overview of the occurrence of five groups of organic contaminants (131 compounds) namely pharmaceuticals, illicit drugs, polar pesticides, estrogens, alkylphenols and related ethoxylates in WWTP tertiary treatment effluents. Data gathered during a period of water reuse carried out in the lower stretch of the Llobregat river (NE Spain), in the surroundings of the town of Barcelona as a consequence of the severe drought that took place along the years 2007-2008 are presented as illustrative example. In general, measured concentrations of the target compounds were in the low to mid ngL(-1) range. The total concentration of each compound class downstream to the discharge point was similar or slightly higher than that found upstream. Regarding the loads calculated for each compound, the relative contribution from the river upstream and the tertiary effluent were highly compound depending with no apparent trend. However, estimation of the overall bulk loads for each compound class determined in the Llobregat river showed the following rank order: pharmaceuticals>alkylphenols>pesticides>illicit drugs≫estrogens.