Seeking prescribing patterns in rural Crete: a pharmacoepidemiological study from a primary care area.

INTRODUCTION: Deliberation of drug prescribing patterns is essential in an effort to improve prescribing standards and quality of care. It is vital for pharmaco-epidemiological research. In this study, data from GPs' practices was used to explore variation in the prescribing patterns in a rural area of Crete. This article reports the findings with respect to the patients' age, sex and diagnoses, and discusses them with the broad aim of identifying areas for practice improvement. METHODS: One thousand prescriptions, issued during a one-year period, were pre-selected from the area of Anogia Health Centre in Crete, Greece. A copy of each pre-selected prescription was made, and a short pre-tested questionnaire with supplementary information about the prescription was filled. Age, gender, prescription through a third person's intervention, and renewal of an old prescription, were registered on this questionnaire. Drugs were classified according to the International Classification of Primary Care--Drugs, and diagnoses according to the International Classification of Primary Care. RESULTS: The vast majority of prescriptions, namely n = 285 (74.2%) for male and n = 481 (78.1%) for female patients, were prescribed for individuals between the ages of 50 and 89 years. The 10 most commonly recorded diagnoses were found in 54.2% of the studied prescriptions for the male population, although only 47% for the female. Hypertension, respiratory infections, and ischaemic heart disease were, over all, the most commonly recorded diseases. The drugs commonly recorded for both sexes were paracetamol and furosemide, as well as some antibiotics. Analysis of the prescribing data revealed that more than one in every three prescriptions was prescribed through a third-person contact and 69.8% (n = 698) of the prescriptions were renewal of an older one. For more than 51% of the cases, the patients asked only for a prescription. The diagnosis 'oral contraceptive' was absent in the study, while there was a large consumption of antibiotics. CONCLUSION: The prescribing patterns illustrated in this study present both similarities with and differences from the registered patterns in other studies. The recognition of these patterns is an essential tool for the GPs who are serving rural areas of Crete, and formulation of practical guidelines on the drugs most often prescribed is anticipated to improve the primary care physicians' performance.

Diagnostic value of interleukin-1alpha, interleukin-6, and tumor necrosis factor in pleural effusions.

STUDY OBJECTIVES: Interleukin (IL)-1alpha, IL-6, and tumor necrosis factor (TNF)-alpha were measured in pleural fluid from 57 patients with pleural effusion in order to evaluate the diagnostic utility of these cytokines. We studied 20 patients with malignant pleural effusion, 11 patients with parapneumonic pleural effusion, 9 patients with tuberculous pleural effusion, and 17 patients with transudative pleural effusion. Cytokines were measured by radioimmunoassay. SETTING: University tertiary hospital. RESULTS: The mean values of the three cytokines measured in pleural fluid or in serum were significantly higher in patients with exudates than with transudates (p < 0.05). The ratio of IL-6 in pleural fluid to serum was significantly higher in exudates than in transudates (p < 0.05). The level of IL-6 in pleural fluid was significantly higher in tuberculous than malignant (p < 0.007) or parapneumonic pleural effusions (p < 0.04). No significant difference between the three types of exudates was found in pleural fluid levels of IL-1alpha or TNF-alpha. CONCLUSIONS: Serum levels of IL-1alpha, TNF-alpha, and in particular IL-6 can distinguish exudates from transudates, while pleural fluid IL-6 levels could be useful as an additional marker in the differential diagnosis of tuberculous, malignant, and parapneumonic exudates. Finally, our results suggest that there is local cytokine production in exudative pleural effusions.