[The French National Compound Library: advances and future prospects]. / Chimiothèque Nationale - Avancées et perspectives.

The French National Compound Library (Chimiothèque Nationale) has been created in 2003 and is the federation of local collections. It contains more than 56 000 small molecules and natural compounds synthesised or isolated in different laboratories over the past years. This explains the diversity of the collection. The strength of this initiative is the ability to connect chemists and biologists for the development of hits. This development involves the synthesis of analogues or/and chemical tools to find new targets. These collaborations lead to the identification of new chemical probes. These probes able to modulate a biological function are essential to study biological pathways. They can also be useful for therapeutic applications. This article will describe the major achievements and perspectives of the French Chemical Library.

Comparative evaluation of different medication safety measures for the emergency department: physicians' usage and acceptance of training, poster, checklist and computerized decision support.

BACKGROUND: Although usage and acceptance are important factors for a successful implementation of clinical decision support systems for medication, most studies only concentrate on their design and outcome. Our objective was to comparatively investigate a set of traditional medication safety measures such as medication safety training for physicians, paper-based posters and checklists concerning potential medication problems versus the additional benefit of a computer-assisted medication check. We concentrated on usage, acceptance and suitability of such interventions in a busy emergency department (ED) of a 749 bed acute tertiary care hospital. METHODS: A retrospective, qualitative evaluation study was conducted using a field observation and a questionnaire-based survey. Six physicians were observed while treating 20 patient cases; the questionnaire, based on the Technology Acceptance Model 2 (TAM2), has been answered by nine ED physicians. RESULTS: During field observations, we did not observe direct use of any of the implemented interventions for medication safety (paper-based and electronic). Questionnaire results indicated that the electronic medication safety check was the most frequently used intervention, followed by checklist and posters. However, despite their positive attitude, physicians most often stated that they use the interventions in only up to ten percent for subjectively "critical" orders. Main reasons behind the low usage were deficits in ease-of-use and fit to the workflow. The intention to use the interventions was rather high after overcoming these barriers. CONCLUSIONS: Methodologically, the study contributes to Technology Acceptance Model (TAM) research in an ED setting and confirms TAM2 as a helpful diagnostic tool in identifying barriers for a successful implementation of medication safety interventions. In our case, identified barriers explaining the low utilization of the implemented medication safety interventions - despite their positive reception - include deficits in accessibility, briefing for the physicians about the interventions, ease-of-use and compatibility to the working environment.

Recomendaciones sobre suplementos de vitamina D y calcio para personas adultas en España / Recommendations on Vitamin D and calcium supplements for adults in Spain

Fundamentos: Los suplementos de calcio y vitamina D están involucrados en debates sanitarios actuales, como la seguridad cardiovascular del calcio y la corrección de los niveles vitamínicos. El objetivo de esta revisión es la evaluación de la información existente de los suplementos de calcio y/o vitamina D disponibles y financiados en España, así como la evaluación de las recomendaciones para su utilización. Métodos: Análisis de la oferta comercial e información disponible sobre aspectos farmacológicos de los suplementos medicamentos españoles en 39 fichas técnicas, guías e informes institucionales y profesionales actualizados, con búsqueda complementaria de información y de datos epidemiológicos españoles relacionados en Cochrane Database of Systematic Reviews®, PubMed® (herramienta "Clinical Queries"), base de datos Dialnet y búsqueda manual en revistas españolas directamente relacionadas. Resultados: No existe uniformidad en cuanto a indicación, expresión de contenido, posologías, precauciones y seguridad ni en fichas técnicas ni en los informes técnicos. La búsqueda bibliográfica ha encontrado un mayor volumen de publicaciones recientes para la vitamina D que para el calcio. No se han encontrado pruebas científicas apropiadas para establecer regímenes posológicos indiscutibles ni universales, ni pruebas de biodisponibilidad para colecalciferol con vehiculización acuosa. En España se constata una situación nutricional generalmente adecuada para el calcio pero un estatus mayoritariamente inadecuado para la vitamina D, con varias referencias de insuficiencia y carencia vitamínica en adultos. Los tratamientos correctores inciden fundamentalmente en el uso de suplementos de calcio. Conclusiones: Existe una amplia oferta de suplementos de calcio y vitamina D en España cuyo diseño farmacológico debería replantearse puesto que no responden a las necesidades detectadas ni a las posibilidades de corrección actualmente recomendadas. También se debería mejorar y mantener actualizada su información, con especial interés en la situación sanitaria relacionada con la hipovitaminosis D(AU)

Background: Calcium supplements and vitamin D are involved in current debates of health, as cardiovascular safety of calcium, and correction of vitamin levels. The aim is to review the possibilities of making better use of supplements marketed in Spain, depending on their availability, information and related epidemiology. Methods: Analysis of comercial offer and available information about pharmacological aspects of Spanish medicinal supplements in data-sheets (39), guides and reports current institutional and professional, with additional search of this information and epidemiological data related Spanish in Cochrane Database of Systematic Reviews ®, Pub- Med ® (tool "Clinical Queries"), Dialnet database and hand search of Spanish journals directly related. Results: There is no uniformity in terms of indication, expression of content, dosages, precautions and safety in data sheets or technical reports. The literature search found more recent publications volume for vitamin D than calcium, No evidence was found to establish appropriate dosing regimens indisputable or universal, or cholecalciferol bioavailability tests with aqueous vehiculización. In Spain nutritional situation is found generally suitable for the calcium but a status mostly unsuitable for vitamin D with several references for insufficiency and vitamin deficiency in adults. Corrective treatments primarily affect calcium supplements. Conclusions: There is an ample supply of calcium and vitamin D in Spain, whose drug design should rethink because don’t respond to the needs identified or correction possibilities currently recommended. It should also improve and update their information, with particular interest in health status related to hypovitaminosis D(AU)

Maternal bodies and medicines: a commentary on risk and decision-making of pregnant and breastfeeding women and health professionals.

BACKGROUND: The perceived risk/benefit balance of prescribed and over-the-counter (OTC) medicine, as well as complementary therapies, will significantly impact on an individual's decision-making to use medicine. For women who are pregnant or breastfeeding, this weighing of risks and benefits becomes immensely more complex because they are considering the effect on two bodies rather than one. Indeed the balance may lie in opposite directions for the mother and baby/fetus. The aim of this paper is to generate a discussion that focuses on the complexity around risk, responsibility and decision-making of medicine use by pregnant and breastfeeding women. We will also consider the competing discourses that pregnant and breastfeeding women encounter when making decisions about medicine. DISCUSSION: Women rely not only on biomedical information and the expert knowledge of their health care professionals but on their own experiences and cultural understandings as well. When making decisions about medicines, pregnant and breastfeeding women are influenced by their families, partners and their cultural societal norms and expectations. Pregnant and breastfeeding women are influenced by a number of competing discourses. "Good" mothers should manage and avoid any risks, thereby protecting their babies from harm and put their children's needs before their own - they should not allow toxins to enter the body. On the other hand, "responsible" women take and act on medical advice - they should take the medicine as directed by their health professional. This is the inherent conflict in medicine use for maternal bodies. SUMMARY: The increased complexity involved when one body's actions impact the body of another - as in the pregnant and lactating body - has received little acknowledgment. We consider possibilities for future research and methodologies. We argue that considering the complexity of issues for maternal bodies can improve our understanding of risk and public health education.

Grado de satisfacción en función de la información recibida por el paciente en la primera prescripción / Satisfaction degree regarding to the information received by the patient in the first prescription

INTRODUCCIÓN.- El objetivo ha sido reflejar el grado de satisfacción del paciente con la información recibida cuando se le prescribe un medicamento por primera vez, en función del tipo de información y del grado de capacitación del que se la proporciona. MATERIAL Y MÉTODOS.- Estudio observacional transversal, realizado en 10 oficinas de farmacia de las provincias de Albacete y Jaén del 1 de abril al 31 de mayo del 2009 entre pacientes o cuidadores que acudieron con un inicio de tratamiento. A dichos sujetos se les realizó una encuesta de satisfacción para cada uno de los medicamentos prescritos y los datos se analizaron con SPSS. RESULTADOS.- Se recogieron un total de 318 encuestas válidas. En el 76,7% de los casos, los pacientes manifestaron estar satisfechos con la información recibida. Cuando la información que se da al paciente es únicamente escrita a mano, el grado de satisfacción es superior al manifestado cuando se da oral o escrita informatizada, destacando el aumento significativo de este grado de satisfacción cuando la información escrita se acompaña de la oral. La satisfacción es mayor en el caso de tratamientos puntuales frente a crónicos y cuando la información la da el médico especialista, aunque la diferencia no es estadísticamente significativa. DISCUSIÓN.- Cuando la información es únicamente escrita informatizada, casi en la mitad de los casos los encuestados no están satisfechos y sólo un tercio comprende todo el tratamiento, cobrando especial relevancia este tema si consideramos que la prescripción informatizada es la que prevalece en nuestro medio(AU)

INTRODUCTION.- The objective has been to reflect the degree of satisfaction shown by the patient with the information received when starting a new treatment. It was based on the type of information and the level of training of the person who provides the information. METHODOLOGY.- Cross-sectional study, carried out in 10 community pharmacies of Albacete and Jaén from the 1st of April to the 31st of May 2009. Patients or their carers completed a survey about satisfaction for each one of the new medicines prescribed. Data obtained was analyzed with SPSS. RESULTS.- 318 valid surveys were collected. In 76,7% of the cases, patients stated to be satisfied with the information received. The level of satisfaction was higher when information was given hand written to the patient in comparison with verbal or computerized written. More over a significant increase of satisfaction was seen when written information was accompanied by verbal one. Satisfaction was greater in acute treatments than in chronic treatments and also when information was given by a consultant. However this difference was found not to be statiscally significant. DISCUSION.- When only computerized written information is supplied, nearly half of the patients are not satisfied and only one third of them understand everything about the new treatment. These findings are very significant for us due to the high number of computerized prescriptions we have to deal within our pharmacies(AU)

Warfarin interactions with substances listed in drug information compendia and in the FDA-approved label for warfarin sodium.

Interactions of warfarin with other drugs or substances can pose a serious problem. We assessed three drug information compendia-Clinical Pharmacology, ePocrates, and Micromedex-and the warfarin sodium (Coumadin) product label (August 2007) approved by the US Food and Drug Administration for listings of interactions between warfarin and drugs, biologics, foods, and dietary supplements. The drug information compendia and warfarin label differed greatly as to the total number of substances that interact with warfarin. Of a total of 648 entries from the four sources, only 50 were common to all the sources. The types of substances listed as interacting with warfarin were entire classes of drugs, individual drugs, and combinations; biologics; dietary supplements; foods; alcohol; and tobacco. These sources were then examined for classification by severity of interaction and the underlying evidence base. This study provides evidence that there is little concordance among commonly used drug compendia and product labels with respect to interactions involving warfarin.

MotherNature: establishing a Canadian research network for natural health products (NHPs) during pregnancy and lactation.

BACKGROUND: It has been estimated that between 7% and 55% of expectant mothers use herbal medicines or other types of natural health products (NHPs). Unfortunately, the safety and efficacy of NHPs during pregnancy and lactation is largely unknown. The Motherisk Program, at the Hospital for Sick Children, Toronto, Ontario, Canada, the is the major Canadian group to counsel and monitor outcomes of women using medications or NHPs, or of women exposed to chemicals, radiation or infection during pregnancy and lactation. OBJECTIVE: To create a network for research on NHPs during pregnancy and lactation by forming longstanding collaborations among Canadian medical and complementary and alternative medicine (CAM) practitioners and scientists. METHODOLOGY: MotherNature Network members participated in three 2-day workshops and three conference calls throughout the length of this study. Each member was responsible to lead discussions surrounding one theme and address the following: initiation; development; presentation; and synthesis of comments of all members on the designated theme. RESULTS: We prioritized areas in high need for future research and collaborative means to conduct such research. NHPs were prioritized for their importance for future study. Areas for the prospective collection of data on NHP use in pregnancy and lactation were identified. A research and business plan was developed for the long-term sustainability of the Network. CONCLUSIONS: The MotherNature Network is well-situated to create a new climate in Canada, where data are collected and interpreted on the effects and safety of NHPs during pregnancy and lactation.

Natural health product labels: is more information always better?

OBJECTIVE: To explore how the information provided on labels as mandated by the new Canadian natural health product (NHP) regulations impacts consumers' perceptions of risks associated with using NHPs. METHODS: Six focus groups were conducted in three locations across Ontario. Consumers were asked to react to two labels for a fictitious product called Saturnflower that represented the "old" standards (label 1) and the new standards (label 2). Groups were audio-taped and transcribed verbatim. Qualitative content analysis was used to identify key themes. RESULTS: The 38 participants criticized label 1 for lacking information about the uses of the product and discussed their frustration at trying to obtain good quality information about NHPs. The lack of risk information on label 1 reinforced their perceptions of NHPs as natural, mild and safe. The majority of participants found label 2 much more informative, but a few were unsettled by the extent of the risk information, questioning if it was necessary. CONCLUSION: The label requirements of the new NHP regulations were generally viewed positively by the consumers who participated in this study. PRACTICE IMPLICATIONS: The additional risk information may generate more NHP-related questions for health care practitioners especially with respect to possible interactions between NHPs and conventional medicines.

A review of the use of CAM therapy and the sources of accurate and reliable information.

OBJECTIVE: To describe how pharmacists can answer the call by the Institute of Medicine (IOM) of the National Academies to become more involved in evaluating complementary and alternative medicine (CAM) and to suggest resources pharmacists can access to be better prepared to advise their patients about these therapies. SUMMARY: Information published by the IOM in January 2005 clearly indicates that the American public considers CAM therapies increasingly to be .conventional. lifestyle choices rather than .alternative. practices. Some managed care organizations (MCOs) have offered CAM services for at least 8 years, and one of the nation.s largest MCOs created a network of CAM providers in 2003 with a 30% discount on provider fees. Pharmacists report an increase in questions regarding the use of herbal products and dietary supplements. As experts in drug-drug interactions, there is the expectation that pharmacists are a source of information for drug-herb interactions. Yet some surveys show pharmacists are uncomfortable answering questions about these products because, although there is an increase in the integration of CAM and conventional medicine, there are few scientific studies available to guide the clinical decisions that are necessary. The Office of Dietary Supplements (ODS) and the National Center for Complementary and Alternative Medicine (NCCAM) have increased funding of CAM research. There is a particular need for clinicians to become involved in assessing the safety and efficacy of these products. At least one health plan has created, through its pharmacy and therapeutics committee, a scientifically based, pocket-sized CAM guide that clinicians rated as somewhat to very helpful as a counseling aid. CONCLUSION: With the increasing volume of information on CAM aimed at consumers by the press, television, Internet, and other media, it is critical for pharmacists to remain current in their knowledge. Pharmacists should know what the IOM is saying about CAM and develop relationships with the CAM providers in their communities. Pharmacists should know what reliable information resources are available and be able to evaluate the literature to help patients and providers interpret what they read and hear. It is important for pharmacists to have access to and be involved in ongoing evaluation of CAM therapies being used by so many people.

Internet websites selling herbal treatments for erectile dysfunction.

The objective of the study was to investigate the safety and reliability of internet websites selling and providing medical information regarding herbal substitutes for Viagra. Using keywords 'Herbal' and 'Viagra', websites selling and providing medical information regarding herbal substitutes were identified. The top 50 sequential sites were assessed for safety and reliability against the Health on the Net (HON) criteria. Medically trained staff provided information in only 21% of the sites yet just 24% stated that the information was not a replacement for medical advice. No sites warned patients about erectile dysfunction (ED)-associated cardiovascular disease. In all, 88 and 70% of sites indicated drug efficacy and ingredients but only 36 and 21% provided contraindications and side effects, respectively. All sites fell short of the HON requirements. In conclusion, acquiring medical information and herbal substitutes for ED from the internet is convenient and easy. However, patients should be cautious as safety and reliability of this approach is poor.

El seguimiento farmacoterapéutico: un componente de la calidad en la atención al paciente / Pharmacotherapy follow-up: as a quality component in patient care

La gestión de la Calidad Total busca la satisfacción del usuario, la implicación activa de los profesionales responsables de su salud y la incorporación de estrategias para la mejora continua de las actividades clínicas, incorporando la búsqueda de la seguridad del paciente como componente principal. La gestión de la seguridad del paciente minimiza las lesiones no intencionadas atribuibles a procesos de la atención sanitaria, incluido el uso de medicamentos. Los principios de seguridad del paciente se aplican en ambos niveles asistenciales y a todos los profesionales sanitarios. Gestionar el riesgo es cuidar al paciente. La Seguridad del paciente pretende resolver problemas y prevenir errores. La aportación del farmacéutico a la seguridad del paciente se realiza con la Atención Farmacéutica y en concreto con el Seguimiento Farmacoterapéutico (SFT) que previene, detecta y resuelve Problemas Relacionados con los Medicamentos (PRM). Uno de los principales problemas para avanzar, es la dificultad para homogeneizar resultados; existen diferencias en las definiciones, al igual que ocurre en el ámbito del medicamento, donde se mezcla permanentemente proceso y resultado: Efecto adverso, Acontecimiento no deseado, Errores de medicación, PRM, etc. Se ha de homogenizar la taxonomia; disponer de una información común permitiría conocer mejor la prevalencia, sus tipos, sus causas, su gravedad así como sus consecuencias. Se quiere caminar hacia la seguridad del paciente evaluando tecnologías su efectividad y su seguridad, acreditando establecimientos y acreditando competencia profesional. Este es el camino también para el SFT que comparte los principios básicos de calidad de la seguridad del paciente. El farmacéutico tiene la responsabilidad profesional y ética de poner a disposición de los pacientes el conocimiento, la experiencia y el método, igual que las acciones emprendidas por los sistemas sanitarios. Existe la oportunidad de estar, de ser los responsables de esta aportación, porque la seguridad del paciente, en general, y en relación al uso de los medicamentos en particular, va a desarrollarse

The principal aim of management of the Quality of Care is to assure patient satisfaction, through the active involvement of health care staff and the incorporation of strategies, whose main aim is to achieve continuous improvement in clinical activities and to incorporate patient safety as one of its principle components. The management of patient safety is a means to minimizing any possible harm to patients in care processes, including the use of medicines. The principles of patient safety can be applied to both levels of patient care and involve all health care professionals. The risk management is an integral part of patient care. Patient safety depends on the solution of problems and the prevention of errors. The pharmacist’s role in patient safety is carried out through Pharmaceutical Care processes and especially through Pharmacotherapy follow-up (PF), which aims to prevent, detect and resolve Drug Therapy Problems (DTP). One of the main difficulties associated with this field is the lack of uniformity of the results obtained throughout the different studies carried out, where differences in definitions occur, as in the classification of drug problems themselves, where process and result are constantly intermingled: Adverse effect, undesirable events, medication errors, DTP, etc. The criteria for classifying such aspects should be uniform, so as to make common information available, which will enable pharmacists to obtain greater knowledge on prevalence, their types, causes, severity and consequences. There is a general desire to improve upon patient safety, to assess the technological processes involved in evaluating effectiveness and safety, and to certify the establishments and health care professionals responsible for such processes. This same approach should also be applied to PF, which is subject to the same basic safety principles. As in the case of all work carried out within the health system, the work of the pharmacist involves the professional and ethical responsibility of making his knowledge, experience and methodology available to his patients. Pharmacists now have the opportunity of making a significant contribution to patient safety, both in general terms and more specifically in the use of medicines, in a field which is currently set for future development

Evaluation of online drug references for identifying over-the-counter solid oral dosage forms.

OBJECTIVE: To evaluate six drug references for their usefulness in identifying over-the-counter (OTC) solid oral dosage forms (SODFs). DESIGN: Retrospective evaluation of a convenience sample of requests for product identification. SETTING: Drug information center that accepts information requests from health care providers and law enforcement officials throughout the state in which it is located. PARTICIPANTS: Researchers. INTERVENTIONS: Using a convenience sample of 68 nonprescription drugs and 41 dietary supplements obtained from the drug information center's question and answer database, researchers sought to identify the SODFs using six drug-identification online databases. MAIN OUTCOME MEASURE: Likelihood of identifying a SODF with a given reference, reported as the percentage identified and the corresponding 95% confidence interval. RESULTS: Overall, 88.2% of nonprescription drugs could be identified using all six references. The highest percentage of nonprescription drugs (77.9%) were identified using Identidex, followed by Ident-A-Drug (67.6%), Drug Identifier (45.6%), RxList (39.7%), Lexi-Drug ID (33.8%), and Clinical Pharmacology (17.6%). Using Ident-A-Drug and RxList together led to the identification of two fewer nonprescription drugs than did Identidex at approximately 5% of the cost. Only 15 (37.5%) of the dietary supplements had an identifying imprint on the dosage form, and 7 (46.6%) of the imprinted products were identified. But overall, only 17.1% (7 of 41) of dietary supplements could be identified, as none of the products without imprints could be positively identified. CONCLUSION: Using these six online references, nonprescription drugs could be identified more frequently than could dietary supplements. The lack of imprints on many dietary supplements is an impediment to identification of these products.

Conocimiento y cumplimiento de procesos administrativos del Seguro Básico de Salud del personal de salud y su relación con la prescripción y la dispensación de medicamentos / Knowledge and execution of administrative processes of the Basic Insurance of the personnel's of health Health and their relationship with the prescription and the dispensation of medications

Pregunta de investigación.- ¿Como se relaciona el conocimiento y cumplimiento de procesos administrativos del Seguro Básico de Salud del Personal de salud, con prescripción y la dispensación de los medicamentos en prestaciones realizadas en los Centros de Salud de Tembladerani y Villa Nuevo Potosí durante el primer semestre del año 2002?.Objetivos.- Determinar la relacion existente entre el conocimiento y cumplimiento de los procesos administrativos del Seguro Básico del personal de salud, en la prescripción y dispensación de los medicamentos en los Centros de Salud de Tembladerani y Villa Nuevo Potosí, durante el primer semestre del 2002. Diseño de investigación.- Estudio, no experimental y correlacion entre 2 variables. Lugar.- Centro de salud Tembladerani y Villa Nueva Potosí. Población.- Revisión de 183 procesos adminsitrativos. Entrevista a 16 funcionarios. Método.- Se registro los procesos administrativos en el formulario calidad de la prescripción y dispensación. Las entrevistas se realizo con el cuestionario conoce y aplia las Normas del Seguro Básico de Salud. Se utilizó estadística descriptiva, T de Student, Prueba Z Normal, Chi cuadrado. Resultados.- No hay relación entre la puntuación obtenida, en el grado de conocimiento y el cumplimiento de Normas por el personal de salud, en relacion a la prescripción y dispensación de medicamentos. Conclusiones.- Del 100 porciento de pacientes que recibió atención médica, el 79 porciento no recibió los medicamentos de acuerdo a normas establecidad por el SEguro Básico de Salud.

Attitudes of physicians toward formularies and services provided by pharmacists.

This study was undertaken to evaluate the attitudes of physicians toward formularies as well as services provided by the pharmacy department in a large integrated delivery system (IDS) with a multispecialty group practice. Surveys were sent to all 282 practitioners in the IDS, requesting information on their use of and satisfaction with the existing printed "Formulary Quick List" (FQL), their satisfaction with pharmacy services, and their attitudes toward formularies in general. A five-point rating scale was used. The response rate was 32%, with the majority from staff physicians. Results indicated that practitioners were very satisfied with the services offered by the pharmacists. Their attitudes toward the FQL were very positive. However, their attitudes toward formularies in general were very negative. There was a significant, negative correlation between attitudes toward formularies in general and attitudes toward pharmacy services, as well as toward the FQL.

Usefulness of herbal and dietary supplement references.

OBJECTIVE: To describe the usefulness of some of the most common tertiary references that healthcare professionals employ to answer requests about herbal and dietary supplements. METHODS: All requests for information on herbal and dietary supplements received by the drug information service between April and September 2000 were evaluated. Each question was independently reviewed by 4 clinicians using a 4-point scale; 14 references were searched for appropriate answers. The percent of responses for each of the possible scores for each reference overall and by category of question was reported to determine the most helpful references for answering the broadest range of questions. RESULTS: Fifty questions regarding herbal and dietary supplements were analyzed. The electronic databases (Natural Medicine Comprehensive Database, Micromedex) and the Internet site (The Natural Pharmacist) were determined to be overall the most helpful references for providing information on herbal and dietary supplements. The Natural Therapeutics Pocket Guide was the most helpful book reference. CONCLUSIONS: These results will facilitate the retrieval of useful information on herbal and dietary supplements and enable healthcare professionals to determine appropriate allocation of resources as they build a drug information library for handling requests about these products.

Evaluation of the ability of seven herbal resources to answer questions about herbal products asked in drug information centers.

STUDY OBJECTIVE: To evaluate the ability of seven widely known herbal references and electronic databases to answer questions about herbal products asked at drug information centers. DESIGN: Cross-sectional study. SETTING: Five academic and institutional drug information centers. METHODS: Fifty-seven herbal-related questions were obtained from academic and institutional drug information centers. Seven herbal references and electronic databases were evaluated for their ability to answer these 57 questions: The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines, 1st edition; Physicians' Desk Reference (PDR) for Herbal Medicines, 2001 edition; Tyler's Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies, 4th edition; The Lawrence Review of Natural Products, 2001; Natural Medicines Comprehensive Database (electronically updated, 2001); The Natural Pharmacist (electronically updated, 2001); and AltMedDex (electronically updated, 2001). RESULTS: Natural Medicines Comprehensive Database outperformed all other products evaluated, providing direct answers to 61% of questions. AltMedDex and The Natural Pharmacist performed similarly to one another, answering 49% and 44% of questions, respectively. The Lawrence Review of Natural Products, PDR for Herbal Medicines, The Complete German Commission E Monographs, and Tyler's Honest Herbal were the least helpful in providing direct answers to the questions (24%, 21%, 11%, and 9%, respectively). CONCLUSION: Natural Medicines Comprehensive Database, AltMedDex, and The Natural Pharmacist outperformed all other evaluated herbal references and electronic databases in their ability to answer questions about herbal products posed in clinical practice.

Quality markers of drug information on the Internet: an evaluation of sites about St. John's wort.

PURPOSE: We aimed to evaluate websites about St. John's wort for the quality of their content, including accuracy as reflected by statement of correct indication and mentioning of interacting drugs, the presence of formal criteria as reflected by adherence to published standards for health information on the Internet, and the validity of individual formal criteria as markers of content quality. SUBJECTS AND METHODS: The Internet was searched with the metasearch engine WebFerret for sites about St. John's wort. A cross-sectional survey of a representative sample of randomly selected sites (n = 208) was performed. The main outcomes were the percentage of sites fulfilling the two criteria of content quality, the percentage of sites exhibiting eight formal criteria, and the associations between formal criteria and criteria of content quality, as determined by multivariate logistic regression analysis. RESULTS: Twenty-two percent (n = 45) of the websites correctly listed depression as the only indication for use of St. John's wort, and 22% (n = 46) identified at least one drug interaction with St. John's wort. Citing scientific publications was associated with mentioning the correct indication (odds ratio [OR] = 4.4; 95% confidence interval [CI]: 1.4 to 14) and mentioning of any interacting drug (OR = 6.0; 95% CI: 2.0 to 18). Absence of financial interest was associated with mentioning the correct indication (OR = 5.4; 95% CI: 2.2 to 14) and interacting drugs (OR = 3.1; 95% CI: 1.2 to 7.7). CONCLUSION: The content quality of sites about St. John's wort was generally poor. Our results suggest that Internet users should prefer noncommercial sites that reference the information to scientific publications when searching for drug information.

The validity of health claims on the World Wide Web: a systematic survey of the herbal remedy Opuntia.

PURPOSE: The World Wide Web has become a significant source of health information for the public, but there is concern that much of the information is inaccurate, misleading, and unsupported by scientific evidence. To explore this issue, the validity of health claims for the herb Opuntia on the World Wide Web was analyzed. DATA SOURCES: From December 1998 to May 1999, health claims were identified from Web sites utilizing nine search engines. A corresponding search was conducted of the scientific literature. Search terms included common and botanical names for Opuntia. INCLUSION AND EXCLUSION CRITERIA: Nutritional support guidelines for herbs were used to identify claims from relevant sites. Scientific studies included established methodological designs with no restrictions on source, language, type of subjects, or dosage forms for Opuntia. DATA EXTRACTION METHODS: A checklist of significant information was prepared for Web sites and scientific studies. The quality of scientific studies was assessed with two instruments, the Jadad and the Journal of the American Medical Association (JAMA) scales. DATA SYNTHESIS: Validity of health claims on Web sites was compared with scientific reports. Searches retrieved 184 Web sites, 98 with health claims and 51 with research studies. Only 34% of the claims were addressed in the scientific literature, and evidence was conflicting or contradictory. For human studies, none met the criteria for high quality as determined by the Jadad and JAMA scales. MAJOR CONCLUSIONS: The majority of health claims were based on folklore or indirect scientific evidence and could not be validated by scientific research. This suggests a need to check the validity of herbal information on the World Wide Web.