Community pharmacy discharge medicines service activity as recorded in PharmOutcomes: a retrospective exploration and analysis.

OBJECTIVES: Transition of care when a patient moves between healthcare locations is a risk factor for medication errors and medicines-related preventable harm. The aims of this retrospective service evaluation were to understand, by classifying and quantifying, the nature of interventions made by community pharmacy when receiving a discharge medicines service referral from a secondary care hospital, with a focus on two groups of high-risk medicines supplied at discharge-oral anticoagulants and weak opioids following hip or knee surgery. METHODS: Records made on the PharmOutcomes™ platform by community pharmacists in response to referral for the NHS England discharge medicines service were analysed and summarized. This analysis was exploratory and interpretative in nature and used a convenience sample of patients who had consented for the service over 12 months from May 2022 to April 2023. KEY FINDINGS: During 12 months, 6811 referrals occurred, of which 71% were recorded as having different stages of the service completed on PharmOutcomes™. Medicines reconciliation, first-prescription review, and consultation stages decreased as patients progressed through the service. Slightly greater rates of completion were observed for patients receiving oral anticoagulants and for codeine or dihydrocodeine following hip and knee surgery, although overall referrals were low for this latter cohort. CONCLUSIONS: Through this service, community pharmacists are well placed to support the safe and effective use of medicines including oral anticoagulants and weak opioids posthospital discharge and potentially reduce incidents of avoidable harm. The variations in recorded completion rates across the three stages of the service and the apparent greater finalization rates for the high-risk medicines studied require further investigation.

Taxonomy development for term standardization in activity resulting from medication review processes: a Delphi study.

BACKGROUND: Medication review (MR) is the systematic assessment of a patient's medications for safety and effectiveness by a healthcare professional. The language used to describe MR activity, such as stopped medicine and increased dose, should be consistent across studies to assist researchers compare how different services operate and identify their mechanism of impact. AIM: To develop an international taxonomy of standardized terms and activity definitions related to medication reviews. METHOD: This was a three-stage Delphi-based consensus study with international medication review experts. A systematic review provided MR activity terms for the survey. Experts rated their consensus on each activity term and its definition on a Likert scale and provided written feedback. The consensus was 75% panel agreement. At each stage, consensus elements were retained, and feedback was used to revise definitions. RESULTS: Seven experts were recruited for the study (response rate 15.2%) from four countries: the United Kingdom (n = 4), New Zealand (n = 1), Australia (n = 1), and Malaysia (n = 1). The following terms achieved consensus: the term Medication as a descriptor for MR terms; discontinue medication, start medication, dose increase, dose decrease, dosage form change, and medication safety and efficacy monitor to describe MR activity; Educate to describe the delivery of healthcare professionals and patients/carers education. CONCLUSION: Standardized medication review activity terms and definitions have been selected for universal adoption in all future MR research to facilitate a meaningful comparison of process evaluations within different settings.

Eleven key measures for monitoring general practice clinical activity during COVID-19: A retrospective cohort study using 48 million adults' primary care records in England through OpenSAFELY.

Background: The COVID-19 pandemic has had a significant impact on delivery of NHS care. We have developed the OpenSAFELY Service Restoration Observatory (SRO) to develop key measures of primary care activity and describe the trends in these measures throughout the COVID-19 pandemic. Methods: With the approval of NHS England, we developed an open source software framework for data management and analysis to describe trends and variation in clinical activity across primary care electronic health record (EHR) data on 48 million adults.We developed SNOMED-CT codelists for key measures of primary care clinical activity such as blood pressure monitoring and asthma reviews, selected by an expert clinical advisory group and conducted a population cohort-based study to describe trends and variation in these measures January 2019-December 2021, and pragmatically classified their level of recovery one year into the pandemic using the percentage change in the median practice level rate. Results: We produced 11 measures reflective of clinical activity in general practice. A substantial drop in activity was observed in all measures at the outset of the COVID-19 pandemic. By April 2021, the median rate had recovered to within 15% of the median rate in April 2019 in six measures. The remaining measures showed a sustained drop, ranging from a 18.5% reduction in medication reviews to a 42.0% reduction in blood pressure monitoring. Three measures continued to show a sustained drop by December 2021. Conclusions: The COVID-19 pandemic was associated with a substantial change in primary care activity across the measures we developed, with recovery in most measures. We delivered an open source software framework to describe trends and variation in clinical activity across an unprecedented scale of primary care data. We will continue to expand the set of key measures to be routinely monitored using our publicly available NHS OpenSAFELY SRO dashboards with near real-time data. Funding: This research used data assets made available as part of the Data and Connectivity National Core Study, led by Health Data Research UK in partnership with the Office for National Statistics and funded by UK Research and Innovation (grant ref MC_PC_20058).The OpenSAFELY Platform is supported by grants from the Wellcome Trust (222097/Z/20/Z); MRC (MR/V015757/1, MC_PC-20059, MR/W016729/1); NIHR (NIHR135559, COV-LT2-0073), and Health Data Research UK (HDRUK2021.000, 2021.0157).

OpenSAFELY NHS Service Restoration Observatory 2: changes in primary care clinical activity in England during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has disrupted healthcare activity across a broad range of clinical services. The NHS stopped non-urgent work in March 2020, later recommending services be restored to near-normal levels before winter where possible. AIM: To describe changes in the volume and variation of coded clinical activity in general practice across six clinical areas: cardiovascular disease, diabetes, mental health, female and reproductive health, screening and related procedures, and processes related to medication. DESIGN AND SETTING: With the approval of NHS England, a cohort study was conducted of 23.8 million patient records in general practice, in situ using OpenSAFELY. METHOD: Common primary care activities were analysed using Clinical Terms Version 3 codes and keyword searches from January 2019 to December 2020, presenting median and deciles of code usage across practices per month. RESULTS: Substantial and widespread changes in clinical activity in primary care were identified since the onset of the COVID-19 pandemic, with generally good recovery by December 2020. A few exceptions showed poor recovery and warrant further investigation, such as mental health (for example, for 'Depression interim review' the median occurrences across practices in December 2020 was down by 41.6% compared with December 2019). CONCLUSION: Granular NHS general practice data at population-scale can be used to monitor disruptions to healthcare services and guide the development of mitigation strategies. The authors are now developing real-time monitoring dashboards for the key measures identified in this study, as well as further studies using primary care data to monitor and mitigate the indirect health impacts of COVID-19 on the NHS.

CATALYST: challenging antibiotic allergy status.

OBJECTIVES: To develop a transferable process, CATALYST (challenging antibiotic allergystatus), to assess and challenge penicillin allergy status of inpatients within an NHS Foundation Hospital. METHODS: A multidisciplinary team (MDT) steering group reviewed existing literature and protocols enabling penicillin allergy assessment, challenge and de-labelling. Using this, they identified five key steps forming the basis of CATALYST: clinical assessment of the nature of allergy; inclusion/exclusion criteria; consent; direct oral penicillin challenge; and removal of allergy label. A pharmacist-led pilot was conducted to assess the process, during which a continuous PDSA (plan-do-study-act) cycle was observed. This included formally auditing endpoint data such as accuracy of allergy status in medical records post-intervention. RESULTS: CATALYST was successfully developed with key resources produced to support clinicians. It was piloted in 304 patients, with 172 patients excluded and 132 successful allergy challenges. There was one incident of an adverse event (acute kidney injury) in the 132 successful patients, which occurred as a delayed reaction following 22 days of penicillin therapy. Only 64% of permanent records (held by GP) were appropriately updated when audited at the end of the pilot. CONCLUSIONS: CATALYST is a transferable process to facilitate safe assessment, challenge and removal of spurious penicillin allergy labels. Handover between care sectors forms a key element of allergy removal to ensure all records are updated and work is needed to ensure this process is done effectively.

Cluster randomised control trial protocol for estimating the effectiveness and cost-effectiveness of a complex intervention to increase care home staff influenza vaccination rates compared to usual practice (FLUCARE).

The care home staff influenza vaccination rate in England is significantly lower than the 75% World Health Organisation recommendation. This represents a substantial potential for resident harm. Barriers to staff vaccination stem from individual and organisational levels. Existing interventions address some but not all barriers and are not underpinned by behavioural science theory. This study aims to estimate the effectiveness and cost-effectiveness of a theory-informed intervention to improve care home staff vaccination rates compared to routine practice.Set in care homes with both nursing and residential focus, and a range of ownership status, only homes providing long stay care to older people with a staff vaccination rate below 40% are eligible to participate. Participation expressions of interest will be sought using a variety of approaches prior to seeking consent.The primary outcome measure is the proportion of staff vaccinated at 6 months, with secondary outcome measures being proportion vaccinated at 3 months, numbers of staff sick days, general practitioner and nurse visits to care home, care home resident hospitalisations and mortality.Based on the assumptions that the mean cluster (care home) size is 54 staff, a coefficient of variation of 0.48, control vaccination rate is 55%, intervention 75%, intra-cluster correlation coefficient of 0.2 and with 90% power, and 20% attrition, we require 39 care homes per arm.Blocked randomisation will be at the level of care home, stratified by the proportion of non-white care home staff, and implemented by Norwich Clinical Trials Unit.The intervention comprises co-designed information videos and posters, provision of in-house staff vaccination clinics, and incentive scheme and monthly data collection on trial outcomes. Beyond usual practice, the control arm will additionally contribute monthly data.Data will be collected at the start, monthly and at 6 months, and analysis will be blind to allocation. Statistical analysis will use the intention-to-treat principle with the difference in vaccination rates between groups compared using a random effect logistic regression model at the staff-level.This will be the first study to use a theory-informed intervention designed to comprehensively address identified barriers to care home staff influenza vaccination.Trial registration: ISRCTN ISRCTN22729870 . Registered on 24 August 22. Secondary identifiers: R209939, IRAS 316820, CPMS 53812.

Barriers and enablers to pharmacists' involvement in a novel immunisation programme.

Aim: Pharmacists are involved in immunisation programmes for a variety of diseases. However, some patient populations may be considered at high risk of complications from vaccination and are excluded from these programmes. The study aimed to explore pharmacists' roles in a vaccination programme to identify factors that influence their involvement. Methods: Phenomenological qualitative semi-structured interviews were conducted online with a convenience sample of pharmacists working in a COVID-19 vaccination centre in January and February 2021, by a single researcher. Recordings of the interviews were transcribed automatically, manually quality checked and thematically analysed using NVivo Version 1 by all authors. Data were repeatedly read to identify what pharmacists did and how they did it. Results: Seventeen pharmacists were interviewed, and transcript analysis identified 1) What pharmacists did in the Vaccination Centre, 2) Barriers to involvement in the Vaccination Centre and 3) Enablers to being involved in the Vaccination Centre. Key findings indicate pharmacists adopted the roles of information counsellors, supporting patients with vaccine hesitancy, making autonomous prescribing decisions as well as documenting product administration and manipulation. Limited free time at work and desk-based roles for senior pharmacists were barriers to taking on a patient-facing role. National recognition of pharmacists' skills, access to information through official and unofficial networks and a sense of duty, or zeitgeist, enabled pharmacists' to be involved. Discussion: Pharmacists can support immunisation for patients during pandemics if given appropriate autonomy and recognition. Further work is needed to explore how pharmacists may be recognised for their work and use information obtained through informal networks.

How Do Pharmacists Practice in Aged Care? A Narrative Review of Models from Australia, England, and the United States of America.

Medication management in residential aged care facilities (RACFs) is complex and often sub-optimal. Pharmacist practice models and services have emerged internationally to address medication-related issues in RACFs. This narrative review aimed to explore pharmacist practice models in aged care in Australia, England and the USA, and identify key activities and characteristics within each model. A search strategy using key terms was performed in peer-reviewed databases, as well as the grey literature. Additionally, experts from the selected countries were consulted to obtain further information about the practice models in their respective countries. Thirty-six documents met the inclusion criteria and were included in the review. Four major pharmacist practice models were identified and formed the focus of the review: (1) the NHS's Medicine Optimisation in Care Homes (MOCH) program from England; (2) the Australian model utilising visiting accredited pharmacists; (3) the Centers for Medicare and Medicaid (CMS) pharmacy services in long-term care from the USA; and (4) the Medication Therapy Management (MTM) program from the USA. Medication reviews were key activities in all models, but each had distinct characteristics in relation to the comprehensiveness, who is eligible, and how frequently residents receive medication review activity. There was heterogeneity in the types of facility-level activities offered by pharmacists, and further research is needed to determine the effectiveness of these activities in improving quality use of medicines in the aged care setting. This review found that in some models, pharmacists have a limited level of collaboration with other healthcare professionals, emphasising the need to trial innovative models with integrated services and increased collaboration to achieve a holistic patient-centred approach to medication management.

Exploring an extended role for pharmacy assistants on inpatient wards in UK hospitals: using mixed methods to develop the role of medicines assistants.

Objectives: This project explored the deployment of pharmacy assistants to inpatient wards in a new role as 'medicines assistants' (MA). Methods: Ward-based MAs were introduced to six wards across two UK hospitals to support medicines administration. Each 30-bed ward delivered acute inpatient services with MAs supporting typical nursing medication administration rounds to 15 patients. Data were collected using activity diaries, observations, clinical audit and semistructured interviews with pharmacy assistants, pharmacy technicians, clinical pharmacists, nurses, ward managers and pharmacy managers. Thematic analysis, descriptive statistics and the Mann-Whitney U test were used to analyse qualitative and quantitative data, respectively. Results: MAs were able to act as a point of contact between the ward and the pharmacy department and were perceived to save nursing time. A statistically significant reduction in the length of time to complete morning medication administration to 15 patients was observed (mean 74.5 vs 60.8 min per round, p<0.05). On average, 17.4 hours of medicines-related activity per ward per week was carried out by MAs rather than by nursing staff. Participants identified broader training and clarity was needed in relation to the accountability and governance of patient-facing roles. Conclusion: Pharmacy assistants deployed as MAs can contribute to saving nursing time and bridge the gap between nursing and pharmacy professionals.

Exploring the use of WhatsApp in out-of-hours pharmacy services: A multi-site qualitative study.

BACKGROUND: WhatsApp is an instant messaging application that has grown in popularity over the last decade. The literature has focused on the use of WhatsApp in medical, surgical and nursing disciplines, with little work exploring pharmacists' experiences of using WhatsApp to provide services. OBJECTIVE(S): The aim of this research was to explore pharmacists' experiences of using WhatsApp to support delivery of out-of-hours pharmacy services. METHODS: A qualitative design was underpinned by a phenomenological philosophy. Focus groups and an extract of the WhatsApp transcript were thematically analysed using NVivo. RESULTS: Over three hundred communication events (1580 messages) were analysed in the WhatsApp transcript. Message type was classified as follows; handover (26%, n = 410), procedural queries (26%, n = 410), laptop location (18%, n = 284), whole staff communication (24%, n = 379), clinical queries (5%, n = 79), and administrative communications (1%, n = 16). A total of five focus groups were conducted between October and November 2017 with 27 participants that included pharmacists with different levels of experience. The findings suggest that WhatsApp improved communication between junior and senior pharmacists, particularly during the global cyber crisis, and provided an opportunity to share best practice. Concerns were raised regarding the encroachment of work activities into personal time. Additionally, the tacit approval by senior pharmacists to group information sharing and solution development, despite the potential for non-active participation, highlighted the issue of collective complicity. CONCLUSIONS: WhatsApp can be a useful platform to support the delivery of out-of-hours services through professional development, improving communication and supporting relationships. This paper demonstrates that service managers must consider multiple ethico-legal and social frameworks when developing or allowing the organic development of such communication methods within healthcare provider organisations.

The Foundation Pharmacist Project: exploring new models of dual-sector postgraduate pharmacy training.

OBJECTIVES: To explore the experiences of primary care-based professional stakeholders in a dual-sector training programme for foundation pharmacists. METHODS: Professional stakeholders were defined as foundation pharmacists or members of staff working with foundation pharmacists such as general medical or nurse practitioners and administrative staff. Stakeholders were invited to participate via email and through gatekeepers. Participants were asked how they were involved in the training pathway, what their experiences had been and what they hoped for the future. Interviews were audio-recorded, transcribed and thematically analysed using computer software. KEY FINDINGS: Twenty-eight face-to-face semi-structured interviews were conducted. Five major themes were identified (1) benefits of integration (2) appropriateness of the work (3) perceived impact (4) identity development and (5) training and peer support. These findings outline participants' experiences of establishing a scope of practice in primary and secondary care settings and developing mechanisms to negotiate non-prescriber status to save general practitioners, practice nurse, community pharmacy and administrator time. Foundation pharmacists were able to develop a professional identity whilst working in each care setting, highlighting the dominance of hospital pharmacy exposure in clinical knowledge acquisition and establishing a community of practice across organisational and geographical boundaries using WhatsApp as a peer support tool. CONCLUSIONS: Foundation pharmacists are able to work within their own competencies in two different care settings, developing scopes of practice and contributing clinically to service provision. This work provides evidence that this type of training pathway can offer an appropriate landscape for pharmacy practitioner development. Further work is needed to explore the longitudinal outcomes of the programme.

Impact of medication review, within a shared decision-making framework, on deprescribing in people living in care homes.

OBJECTIVES: The key objectives of this study were to quantify extent of prescribing, reasons for deprescribing, common therapeutic groups of medicines deprescribed and adverse events. METHODS: A retrospective analysis was carried out on a quality improvement project where 422 care home residents in 20 care homes received a medicines optimisation review with a pharmacist and other members of the healthcare team (general medical practitioner, care home nurse). Data on number, type and cost of medicines were collected. Statistical analysis was performed to test for differences between pharmacist-only review and the pharmacist plus general practitioner (GP), and to identify any correlation between the original number of medicines and the number of medicines stopped. RESULTS: Of the 422 patients reviewed, 298 (70.6%) had at least one medicine stopped with 704 medicines being stopped. This represented 19.5% of the medicines originally prescribed (3602 medicines). There was no statistically significant difference between pharmacist only and pharmacist plus GP in terms of stopping medicines. The main groups of medicines stopped were laxatives, skin products and bone protection. There was weak correlation between the original number of medicines prescribed and the number stopped. CONCLUSIONS: This study has shown that medicines optimisation reviews can lead to a reduction in polypharmacy for care home residents through a deprescribing process. Patients' medicine regimens were simplified and optimised while making financial significant savings for the National Health Service.

Pharmacist independent prescribing in secondary care: opportunities and challenges.

In recent years a number of countries have extended prescribing rights to pharmacists in a variety of formats. The latter includes independent prescribing, which is a developing area of practice for pharmacists in secondary care. Potential opportunities presented by wide scale implementation of pharmacist prescribing in secondary care include improved prescribing safety, more efficient pharmacist medication reviews, increased scope of practice with greater pharmacist integration into acute patient care pathways and enhanced professional or job satisfaction. However, notable challenges remain and these need to be acknowledged and addressed if a pharmacist prescribing is to develop sufficiently within developing healthcare systems. These barriers can be broadly categorised as lack of support (financial and time resources), medical staff acceptance and the pharmacy profession itself (adoption, implementation strategy, research resources, second pharmacist clinical check). Larger multicentre studies that investigate the contribution of hospital-based pharmacist prescribers to medicines optimisation and patient-related outcomes are still needed. Furthermore, a strategic approach from the pharmacy profession and leadership is required to ensure that pharmacist prescribers are fully integrated into future healthcare service and workforce strategies.

Reducing unacceptable missed doses: pharmacy assistant-supported medicine administration.

OBJECTIVES: The potential harm from omitted and delayed medicines for hospital inpatients was highlighted by the National Patient Safety Agency (NPSA). Despite evidence of omitted doses, few interventional studies have been reported on preventing the problem. This study aimed to assess the impact on omitted doses when medicine administration was supported by pharmacy assistants (PAs). METHODS: PAs were trained to support nurses on medicine administration rounds. Using stratified random sampling, two intervention and control wards were selected. Three study groups were defined: (A) intervention group (PA-supported medicine administration); (B) intra-ward control group; and (C) inter-ward control group. Primary outcome measure was number of patients with unacceptable omitted doses (UODs) in group A versus C. Secondary outcome measures were patients with critical UOD (cUOD), as defined by the NPSA, in groups A, B and C and UODs in group B versus A and C. Data were collected over 2 weeks (December 2011 and February 2012). KEY FINDINGS: Using aggregated data over 2 weeks, 778 patients were assessed; 308 were male (40%). The overall proportion of patients with ≥1 UOD was 12.4% (n = 96). The proportion of patients with ≥1 UOD was 1.1% (n = 2) in group A (intervention) and 18.5% (n = 68) in group C (control). There were significantly fewer patients with cUOD in group A (1.1%; n = 2) compared with group C (7.4%; n = 27). CONCLUSION: PA-supported medication rounds can significantly reduce the rate of omitted doses. This study provides evidence for a potential solution to the problem of omitted doses for hospital inpatients.

A clinico-ethical framework for multidisciplinary review of medication in nursing homes.

Residents in care homes are more likely to be prescribed multiple medicines yet often have little involvement in these prescribing decisions. Reviewing and stopping inappropriate medicines is not currently adopted across the health economy. This Health Foundation funded Shine project developed a pragmatic approach to optimising medicines in care homes while involving all residents in decision making. The pharmacist undertook a detailed medication review using primary care records. The results were discussed at a multidisciplinary team (MDT) meeting involving the care home nurse and the resident's general practitioner (GP), with input from the local psychiatry of old age service (POAS) where appropriate. Suggestions for medicines which should be stopped, changed or started, and other interventions (eg monitoring) were discussed with the resident and/or their family. Over 12 months 422 residents were reviewed, and 1346 interventions were made in 91% of residents reviewed with 15 different types of interventions. The most common intervention (52.3%) was to stop medicines; 704 medicines stopped in 298 residents (70.6%). On average, 1.7 medicines were stopped for every resident reviewed (range zero to nine medicines; SD=1.7), with a 17.4% reduction in medicines prescribed (3602 medicines prescribed before and 2975 after review). The main reasons for stopping medicines were: no current indication (401 medicines; 57%), resident not wanting medicine after risks and benefits were explained (120 medicines; 17%), and safety concerns (42 medicines; 6%). The net annualised savings against the medicines budget were £77,703 or £184 per person reviewed. The cost of delivering the intervention was £32,670 (pharmacist, GP, POAS consultant, and care home nurse time) for 422 residents; for every £1 invested, £2.38 could be released from the medicines budget. This project demonstrated that a multidisciplinary medication review with a pharmacist, doctor, and care home nurse can safely reduce inappropriate medication in elderly care home residents.

Patients with advanced lung cancer: is there scope to discontinue inappropriate medication?

BACKGROUND: Polypharmacy-taking five or medications per day-is common in lung cancer patients. This patient group is prescribed medication to control acute symptoms associated with cancer and also to prevent or treat other long-term conditions. These medications increase the pill burden for the patient and also the probability of developing a drug-related toxicity. OBJECTIVE: To assess the prevalence of inappropriate medication in patients taking erlotinib for the treatment of advanced non-small cell lung cancer. METHOD: This was a multicentre study across three sites in the North of England. Medication histories for patients receiving erlotinib were retrospectively extracted from medical notes and assessed by the clinical team (a consultant pharmacist, nurse specialist and clinical oncologist) to determine if the medication was appropriate or inappropriate. The clinical team considered the following factors when deciding if the medication was appropriate or inappropriate: remaining life expectancy of the patient, time until benefit of the treatment, goals of care and treatment targets. RESULTS: Among the 20 patients assessed, 19 (95 %) according to the clinical team were taking medications that were inappropriate. The mean number of medications the patients were taking was 8 (range 1-16) and the most common class of medication used were drugs affecting the Central Nervous System. In addition, there were 11 patients (55 %) who were taking erlotinib in combination with a proton pump inhibitor (PPI)-a clinically significant drug interaction that impairs the absorption of erlotinib. CONCLUSIONS: Patients taking erlotinib for the treatment of advanced non-small cell lung cancer take many inappropriate medications for the treatment or prevention of long-term conditions. These patients should have their medications reviewed in the context of their original therapeutic goals.

Disclosure and adverse effects of complementary and alternative medicine used by hospitalized patients in the North East of England / Advertencias y efectos adversos de las medicinas alternativas y complementarias usadas por pacientes hospitalizados en el noreste de Inglaterra

Objectives: This study aimed to investigate the prevalence, disclosure and adverse effects of complementary and alternative medicine (CAM) use in hospitalised patients, and to explore the associations between patients’ perceived sideeffects and relevant factors. Methods: Patients who were admitted to a district general hospital and met the eligibility criteria were interviewed using a semi-structured questionnaire. Their medications and pertinent details were verified from the medical notes. All quantitative and qualitative data were collated and analysed. A chisquared test was performed to test the associations of the perceived CAM side-effects with the significance level determined at α=0.05. Results: A total of 240 in-patients completed the study. They were mostly white British (98.8%). The prevalence of CAM use within two years was 74.6% and one month 37.9%. Only 19 of 91 patients (20.9%) using CAM within one month disclosed their current CAM applications. Nearly half of patients (45.8%) who used CAM within two years experienced various CAM side-effects that tended to resolve after discontinuation. Slightly more than half (57.6%) perceived CAM side-effects and their perceptions were significantly associated with gender (P=0.048) and consideration for future CAM use (P=0.033). Potential interactions between herbal remedies/dietary supplements and prescribed drugs, such as garlic with lisinopril or aspirin, were assessed in 82 patients (45.8%). Conclusion: Most in-patients used CAM and experienced some adverse effects. The disclosure of CAM use and its adverse outcomes should be encouraged by healthcare professionals (AU)

Objetivos: Este estudio trató de investigar la prevalencia, advertencia y efectos adversos de las medicinas alternativas y complementarias (CAM) usadas por pacientes hospitalizados, y explorar las asociaciones entre los efectos adversos percibidos por los pacientes y factores relevantes. Métodos: Se entrevistó usando un cuestionario semi-estructurado a los pacientes que fueron admitidos en un hospital general distrital y que cumplían los criterios de elegibilidad. Se comprobaron los medicamentos y otros detalles pertinentes en la historia clínica de los pacientes. Se recogieron y analizaron todos los datos cuantitativos y cualitativos. Para comprobar las asociaciones de los efectos adversos percibidos de las CAM se realizó un test chi-cuadrado con un nivel de significación de α=0,05. Resultados: Un total de 240 pacientes hospitalizados completó el estudio. Eran mayoritariamente británicos (98,8%). La prevalencia de uso de CAM en dos años fue del 74,6% y en un mes del 37,9%. Sólo 19 de los 91 pacientes (20,9%) que usaron CAM en el último mes reveló su uso actual. Casi la mitad de los pacientes (45,8%) que usaron CAM en los dos últimos años sufrió algunos efectos adversos de las CAM que tendieron a resolverse después de abandonarlas. Ligeramente más de la mitad (57,6%) percibieron efectos adversos de las CAM y su percepción estaba significativamente asociada con el género (P=0,048) y con la consideración sobre el futuro uso de CAM (P=0,033). En 82 pacientes (45,8%) se encontró interacciones potenciales entre plantas medicinales/suplementos dietéticos y medicamentos prescritos, tales como ajo con lisinoprilo o aspirina. Concusión: La mayoría de los pacientes hospitalizados usó CAM y percibió algunos efectos adversos. La advertencia del uso de CAM y sus efectos adversos debería ser incentivada por los profesionales de la salud (AU)

Disclosure and adverse effects of complementary and alternative medicine used by hospitalized patients in the North East of England.

OBJECTIVE: This study aimed to investigate the prevalence, disclosure and adverse effects of complementary and alternative medicine (CAM) use in hospitalised patients, and to explore the associations between patients' perceived side-effects and relevant factors. METHODS: Patients who were admitted to a district general hospital and met the eligibility criteria were interviewed using a semi-structured questionnaire. Their medications and pertinent details were verified from the medical notes. All quantitative and qualitative data were collated and analysed. A chi-squared test was performed to test the associations of the perceived CAM side-effects with the significance level determined at α=0.05. RESULTS: A total of 240 in-patients completed the study. They were mostly white British (98.8%). The prevalence of CAM use within two years was 74.6% and one month 37.9%. Only 19 of 91 patients (20.9%) using CAM within one month disclosed their current CAM applications. Nearly half of patients (45.8%) who used CAM within two years experienced various CAM side-effects that tended to resolve after discontinuation. Slightly more than half (57.6%) perceived CAM side-effects and their perceptions were significantly associated with gender (P=0.048) and consideration for future CAM use (P=0.033). Potential interactions between herbal remedies/dietary supplements and prescribed drugs, such as garlic with lisinopril or aspirin, were assessed in 82 patients (45.8%). CONCLUSIONS: Most in-patients used CAM and experienced some adverse effects. The disclosure of CAM use and its adverse outcomes should be encouraged by healthcare professionals.

Are sugars-free medicines more erosive than sugars-containing medicines? An in vitro study of paediatric medicines with prolonged oral clearance used regularly and long-term by children.

OBJECTIVE: The reduced use of sugars-containing (SC) liquid medicines has increased the use of other dose forms, potentially resulting in more widespread dental effects, including tooth wear. The aim of this study was to assess the erosive potential of 97 paediatric medicines in vitro. METHODS: The study took the form of in vitro measurement of endogenous pH and titratable acidity (mmol). Endogenous pH was measured using a pH meter, followed by titration to pH 7.0 with 0.1-M NaOH. RESULTS: Overall, 55 (57%) formulations had an endogenous pH of < 5.5. The mean (+/- SD) endogenous pH and titratable acidity for 41 SC formulations were 5.26 +/- 1.30 and 0.139 +/- 0.133 mmol, respectively; for 56 sugars-free (SF) formulations, these figures were 5.73 +/- 1.53 and 0.413 +/- 1.50 mmol (P > 0.05). Compared with their SC bioequivalents, eight SF medicines showed no significant differences for pH or titratable acidity, while 15 higher-strength medicines showed lower pH (P = 0.035) and greater titratable acidity (P = 0.016) than their lower-strength equivalents. Chewable and dispersible tablets (P < 0.001), gastrointestinal medicines (P = 0.002) and antibiotics (P = 0.007) were significant predictors of higher pH. In contrast, effervescent tablets (P < 0.001), and nutrition and blood preparations (P = 0.021) were significant predictors of higher titratable acidity. CONCLUSIONS: Paediatric SF medicines were not more erosive than SC medicines in vitro; a more significant predictor of their erosive potential was dose form.