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1.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-33431440

RESUMEN

A healthy multiparous woman presented at 35 weeks and 4 days' gestation with threatened preterm labour on multiple occasions. An incidental finding of severe hypokalaemia (2.4 mmol/L) was detected on routine blood tests. The cause of this hypokalaemia was not initially obvious. It was eventually linked to overuse of over-the-counter antacids for pregnancy-associated heartburn. The patient was managed with parenteral and then oral electrolyte replacement which corrected a pH of 7.55, bicarbonate of 36.7 mEq/L and a base excess 13.1. In this case report we consider whether hypokalaemia could be linked to uterine irritability and threatened preterm labour, whether antacids were being abused in the context of an eating disorder and the importance of taking a full drug history.


Asunto(s)
Antiácidos/envenenamiento , Sobredosis de Droga/diagnóstico , Hipopotasemia/diagnóstico , Medicamentos sin Prescripción/envenenamiento , Nacimiento Prematuro/etiología , Adulto , Antiácidos/administración & dosificación , Cardiotocografía , Sobredosis de Droga/sangre , Sobredosis de Droga/etiología , Femenino , Reflujo Gastroesofágico/tratamiento farmacológico , Humanos , Hipopotasemia/sangre , Hipopotasemia/inducido químicamente , Hipopotasemia/complicaciones , Hallazgos Incidentales , Recién Nacido , Recien Nacido Prematuro , Masculino , Medicamentos sin Prescripción/administración & dosificación , Omeprazol/uso terapéutico , Potasio/sangre , Embarazo
2.
J Drugs Dermatol ; 19(12): 802, 2020 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-33346515

RESUMEN

Cultural and social constructs may influence a patient’s understanding of their acne vulgaris affecting treatment preferences and valuation. Understanding these differences can better equip healthcare professionals when providing treatment recommendations. The objective of this study was to determine how perception, treatment preferences, and treatment valuation of acne vulgaris vary across different races. This was a cross-sectional study run from June 2017–February 2018. Participants with self-identified acne completed a one-time 31 question online survey distributed through ResearchMatch (national research registry) and campus recruitment. 217 English-speaking participants with self-identified acne who were over 18 years-old attempted the survey, and 3 participants were excluded for failing to complete it. Response rate of this study was 10.5%. Compared to Whites (88%, n=126), East Asians (44%, n=12) (P<0.001) and South Asians (53%, n=16) (P=0.002) were less likely to see a healthcare professional for acne. Compared to Whites (87%, n=125), East Asians (63%, n=17) were less likely to get information from healthcare professionals (P=0.03). East Asians (93%, n=25) used the internet more frequently as a source of information about causes of acne and treatments compared to all other races (P=0.04). Race was not statistically significant as a predictor for willingness to pay (WTP). Whites (27%, n=39) preferred using prescription face washes/creams/gels, while East Asians (41%, n=11), South Asians (60%, n=18), and Blacks (37%, n=7) preferred OTC washes/creams/gels. Differences exist in perception and treatment preferences for acne between races and exploring them may enhance providers’ understanding of their patients’ preferences. Healthcare organizations and professionals may need to utilize the internet and social media to access non-White populations. J Drugs Dermatol. 2020;19(12): doi:10.36849/JDD.2020.5488.


Asunto(s)
Acné Vulgar/tratamiento farmacológico , Fármacos Dermatológicos/administración & dosificación , Aceptación de la Atención de Salud/psicología , Prioridad del Paciente/estadística & datos numéricos , Cuidados de la Piel/psicología , Adolescente , Adulto , Grupo de Ascendencia Continental Africana/estadística & datos numéricos , Anciano , Grupo de Ascendencia Continental Asiática/estadística & datos numéricos , Comparación Transcultural , Estudios Transversales , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Humanos , Conducta en la Búsqueda de Información , Internet , Masculino , Persona de Mediana Edad , Medicamentos sin Prescripción/administración & dosificación , Aceptación de la Atención de Salud/estadística & datos numéricos , Medicamentos bajo Prescripción/administración & dosificación , Autoinforme/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Cuidados de la Piel/métodos , Cuidados de la Piel/estadística & datos numéricos , Adulto Joven
3.
PLoS One ; 15(9): e0239873, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32976542

RESUMEN

Widespread availability of antibiotics without prescription potentially facilitates overuse and contributes to selection pressure for antimicrobial resistant bacteria. Prior to this study, anecdotal observations in Guatemala identified corner stores as primary antibiotic dispensaries, where people purchase antibiotics without prescriptions. We carried out a cross sectional study to document the number and types of antibiotics available in corner stores, in four study areas in Guatemala. A total of 443 corner stores were surveyed, of which 295 (67%) sold antibiotics. The most commonly available antibiotics were amoxicillin, found in 246/295 (83%) stores, and tetracycline, found in 195/295 (66%) stores. Over the counter sales result from laissez-faire enforcement of antibiotic dispensing regulations in Guatemala combined with patient demand. This study serves as a baseline to document changes in the availability of antibiotics in informal establishments in light of new pharmacy regulations for antibiotic dispensing, which were adopted after this study was completed.


Asunto(s)
Antibacterianos/provisión & distribución , Utilización de Medicamentos/estadística & datos numéricos , Medicamentos sin Prescripción/provisión & distribución , Autoadministración/estadística & datos numéricos , Antibacterianos/administración & dosificación , Antibacterianos/economía , Abuso de Medicamentos/estadística & datos numéricos , Guatemala , Humanos , Medicamentos sin Prescripción/administración & dosificación , Medicamentos sin Prescripción/economía , Pequeña Empresa/estadística & datos numéricos
4.
Medicine (Baltimore) ; 99(39): e22274, 2020 Sep 25.
Artículo en Inglés | MEDLINE | ID: mdl-32991427

RESUMEN

BACKGROUND: Anxiety is the most common mental illness among adolescents and children, and its incidence is increasing year by year, which has a serious adverse effect on the academic and growth of adolescents and children. Conventional treatment methods such as oral administration of western medicine and psycho-behavioral therapy have obvious limitations. Chinese patent medicines play an irreplaceable role in the treatment of this disease. At present, there is no comparison of the safety and effectiveness of various Chinese patent medicines curing anxiety in adolescents. So we take advantage of the method of network meta-analysis to systematically compare the efficacy of various Chinese patent medicines curing this disease. METHODS: We will systematically and comprehensively search the following databases, including PubMed, Web of Science, EMBASE, The Cochrane Library, China BioMedical Literature (CBM), China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), and Wanfang database. We will include all RCT trials that meet the inclusion criteria, starting from the establishment of the database until August 2020. Two researchers will independently screen the literature based on inclusion criteria. While extracting data, we also assess the risk of bias in the included studies. All the data and evidence obtained will be evaluated by the method of Bayesian network meta-analysis. STATA and WinBUGS software will be used. RESULTS: This study will evaluate the effectiveness and safety of various TCPMs for anxiety disorders in children or adolescence. CONCLUSION: The results of this study will provide valuable references for the clinical application of Traditional Chinese patent medicines, and assist clinicians in formulating more reasonable diagnosis and treatment strategies. ETHICS AND DISSEMINATION: This study does not require ethical approval. INPLASY REGISTRATION NUMBER: INPLASY202080048.


Asunto(s)
Trastornos de Ansiedad/tratamiento farmacológico , Medicina China Tradicional/métodos , Medicamentos sin Prescripción/uso terapéutico , Adolescente , Teorema de Bayes , Niño , Protocolos Clínicos/normas , Humanos , Metaanálisis en Red , Medicamentos sin Prescripción/administración & dosificación , Ensayos Clínicos Controlados Aleatorios como Asunto , Seguridad , Resultado del Tratamiento
5.
PLoS One ; 15(9): e0238538, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32881969

RESUMEN

Self-medication and antibiotic utilization without healthcare oversight may lead to delayed appropriate treatment, transmission of communicable infections, untoward adverse events, and contribute to antimicrobial resistance. Previous data suggest people obtain over-the-counter (OTC) animal antibiotics for their personal use. This study examined the availability of OTC fish antibiotics online and the documented intent for self-medication. The authors conducted a web-based cross-sectional study using Google search engine to identify vendor websites selling fish antibiotics in the United States. Vendor websites were included if product information, consumer reviews, and comments were publicly available. Nine fish antibiotics were chosen due to their possibility of having consequences to human misuse. The cost and availability of fish antibiotics was recorded. The proportion of reviews and comments related to human consumption was calculated. Consumer review traffic based on "likes" and "dislikes" received was compared between human- and non-human consumption-related reviews. Selected fish antibiotics were purchased and evaluated for physical appearance and compared to FDA-approved available equivalents. We found 24 website vendors with online ordering available for OTC fish antibiotics. Cost varied significantly by antibiotic and quantity ranging from USD $8.99 to $119.99. There were 2,288 reviews documented for the 9 selected antibiotics being sold. Among consumer reviews, 2.4% were potentially associated with human consumption. Human consumption-related reviews constituted 30.2% of all "likes" received and 37.5% of all "dislikes" received. Human consumption-related reviews received an average of 9.2 likes compared to 0.52 likes for non-human consumption-related reviews. The 8 fish antibiotics purchased were consistent with FDA-approved equivalents in physical appearance. Although infrequent, antibiotics intended for fish use are being purchased online without a prescription for self-medication to circumvent professional medical care. Reviews related to human consumption generate significant online traffic compared to reviews unrelated to human consumption.


Asunto(s)
Antibacterianos/administración & dosificación , Abuso de Medicamentos/estadística & datos numéricos , Medicamentos sin Prescripción/administración & dosificación , Disponibilidad de Medicamentos Vía Internet/estadística & datos numéricos , Automedicación/estadística & datos numéricos , Drogas Veterinarias/administración & dosificación , Estudios Transversales , Humanos , Conocimiento de la Medicación por el Paciente , Motor de Búsqueda/estadística & datos numéricos , Estados Unidos
7.
Int Rev Immunol ; 39(4): 153-162, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32347747

RESUMEN

The current COVID-19 pandemic is one of the most devastating events in recent history. The virus causes relatively minor damage to young, healthy populations, imposing life-threatening danger to the elderly and people with diseases of chronic inflammation. Therefore, if we could reduce the risk for vulnerable populations, it would make the COVID-19 pandemic more similar to other typical outbreaks. Children don't suffer from COVID-19 as much as their grandparents and have a much higher melatonin level. Bats are nocturnal animals possessing high levels of melatonin, which may contribute to their high anti-viral resistance. Viruses induce an explosion of inflammatory cytokines and reactive oxygen species, and melatonin is the best natural antioxidant that is lost with age. The programmed cell death coronaviruses cause, which can result in significant lung damage, is also inhibited by melatonin. Coronavirus causes inflammation in the lungs which requires inflammasome activity. Melatonin blocks these inflammasomes. General immunity is impaired by anxiety and sleep deprivation. Melatonin improves sleep habits, reduces anxiety and stimulates immunity. Fibrosis may be the most dangerous complication after COVID-19. Melatonin is known to prevent fibrosis. Mechanical ventilation may be necessary but yet imposes risks due to oxidative stress, which can be reduced by melatonin. Thus, by using the safe over-the-counter drug melatonin, we may be immediately able to prevent the development of severe disease symptoms in coronavirus patients, reduce the severity of their symptoms, and/or reduce the immuno-pathology of coronavirus infection on patients' health after the active phase of the infection is over.


Asunto(s)
Antioxidantes/administración & dosificación , Betacoronavirus/inmunología , Infecciones por Coronavirus/prevención & control , Melatonina/administración & dosificación , Medicamentos sin Prescripción/administración & dosificación , Pandemias/prevención & control , Neumonía Viral/prevención & control , Factores de Edad , Anciano , Envejecimiento/inmunología , Animales , Betacoronavirus/patogenicidad , Quirópteros/inmunología , Quirópteros/virología , Ritmo Circadiano/efectos de los fármacos , Ritmo Circadiano/inmunología , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/virología , Humanos , Fotoperiodo , Neumonía Viral/inmunología , Neumonía Viral/virología
8.
Clin Toxicol (Phila) ; 58(2): 99-106, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31062642

RESUMEN

Introduction: Diphenhydramine (DPH) exposures in children may be the result of accidental unsupervised ingestions, caregiver error, and intentional misuse of DPH-containing cough and cold medications (CCM). We sought to understand the nature of pediatric ingestions of DPH, particularly the toxicity and outcome of a single product, single ingredient DPH (DPH-only) exposures, in order to derive ingredient-specific information about the clinical effects and course of such cases.Methods: As part of a U.S. multi-year safety surveillance program to assess the safety of over-the-counter (OTC) medications used in cough and cold preparations in children <12 years of age, an expert panel reviewed cases involving symptomatic adverse events potentially related to oral exposures to these medications. After individual review, the cases were categorized by causal relationship of the reported ingredients to the adverse event, exposure intent (therapeutic, non-therapeutic, unknown intent), and dose (therapeutic, supratherapeutic, or unknown). Following panel review, any disagreement on classification was discussed until a consensus was reached. The data were then analyzed with respect to descriptive findings.Results: The panel reviewed 6618 eligible cases and determined 2802 were at least potentially related to oral exposure to DPH. Of these, 2028 were DPH-only cases (39.1% of all cases judged at least potentially related to a cough and cold medication). The majority (79.5%) of DPH-only cases occurred in children 2 to <4 years of age and involved accidental unsupervised ingestions (74.7%). Liquid pediatric formulations were the most common (51.7%) products reported followed by solid pediatric formulations (24.0%). The most common adverse events were tachycardia (53.4%), hallucinations (46.5%), somnolence (34.7%), agitation (33.9%), and mydriasis (26.3%). Seizures occurred in only 5.5% of cases. Five (0.2%) deaths were reported; in the death cases, the DPH dose was judged supratherapeutic in one and unknown in the other four. Child abuse was reported in four of the five death cases and three of the five deaths were homicides.Conclusions: Exposures to DPH-only products were the most common type of exposure detected in our study of adverse events associated with CCM in children. The majority of the DPH-only cases were the result of accidental unsupervised ingestions. Most adverse events were relatively mild self-limited anticholinergic effects and few deaths occurred. Deaths involving DPH were often associated with child abuse or homicide. Interventions targeting the prevention of accidental unsupervised are likely to be impactful in preventing morbidity associated with DPH-only exposure.


Asunto(s)
Antitusígenos/efectos adversos , Difenhidramina/efectos adversos , Medicamentos sin Prescripción/efectos adversos , Sistemas de Registro de Reacción Adversa a Medicamentos , Antitusígenos/administración & dosificación , Antitusígenos/uso terapéutico , Niño , Tos/tratamiento farmacológico , Difenhidramina/administración & dosificación , Difenhidramina/uso terapéutico , Humanos , Medicamentos sin Prescripción/administración & dosificación , Medicamentos sin Prescripción/uso terapéutico
9.
Addict Sci Clin Pract ; 14(1): 41, 2019 11 12.
Artículo en Inglés | MEDLINE | ID: mdl-31718716

RESUMEN

BACKGROUND: Dependence to prescription and over-the-counter (OTC) drugs represents an increasing public health and clinical problem both in England and internationally. However, relatively little is known about those affected, particularly in relation to their management at drug dependence treatment centres. This study aimed to explore the views and experiences of health care professionals (HCPs) working in formal drug treatment services in relation to supporting clients with prescription and OTC drug dependence. METHODS: An exploratory, qualitative design was used involving semi-structured telephone interviews. 15 staff were recruited using purposive sampling to represent a variety of different professional roles, funding (NHS, charity and local government) and geographical locations across England. Transcribed interviews were analysed using Braun and Clarke's six stage thematic analysis. RESULTS: Current services were considered to be inappropriate for the treatment of OTC and prescription drug dependence, which was perceived to be a significantly under-recognised issue affecting a range of individuals but particularly those taking opioid analgesics. Negativity around current treatment services involved concerns that these were more suited for illicit drug users and this was exacerbated by a lack of specific resources, funding and commissioning. There was a perceived variation in service provision in different areas and a further concern about the lack of formal treatment guidelines and care pathways. Participants felt there to be stigma for affected clients in both the diagnosis of OTC or prescription drug dependence and also attendance at drug treatment centres which adversely impacted service engagement. Suggested service improvements included commissioning new specific services in general practices and pain management clinics, developing national guidelines and care pathways to ensure equal access to treatment and increasing awareness amongst the public and HCPs. CONCLUSIONS: This study reveals considerable negativity and concern about current treatment services for prescription and OTC drug dependence in England from the perspective of those working in such services. Policy and practice improvement are suggested to improve outcomes for this neglected group in relation to increasing funding, guidelines and awareness.


Asunto(s)
Actitud del Personal de Salud , Medicamentos sin Prescripción/administración & dosificación , Medicamentos bajo Prescripción/administración & dosificación , Centros de Tratamiento de Abuso de Sustancias/organización & administración , Trastornos Relacionados con Sustancias/rehabilitación , Adulto , Analgésicos Opioides/administración & dosificación , Vías Clínicas/normas , Inglaterra/epidemiología , Femenino , Financiación Gubernamental , Accesibilidad a los Servicios de Salud/normas , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto/normas , Investigación Cualitativa , Estigma Social , Medicina Estatal , Centros de Tratamiento de Abuso de Sustancias/economía , Centros de Tratamiento de Abuso de Sustancias/normas
10.
Int J Drug Policy ; 74: 216-222, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31677483

RESUMEN

BACKGROUND: In recent years there have been growing concerns regarding non-prescription codeine use in Australia. Efforts to mitigate risks associated with non-prescription codeine, such as addiction and toxicity, have been primarily through two initiatives; regulatory changes restricting their availability, and voluntary live-recording supply of non-prescription codeine combination analgesics (CCAs). This study sought to explore the supply of CCAs in the climate of regulatory change. METHODS: Eighty University of Sydney pharmacy students mystery-shopped 34 community pharmacies across metropolitan Sydney, Australia from August 2016 to November 2017, with scripted symptom-based (SBR) or direct product requests (DPR) for a CCA. Questions asked, staff involvement, regulatory compliance, voluntary recording, and product(s) supplied were recorded. RESULTS: Of 158 total visits, a non-prescription CCA was supplied in 101 instances. Sixty-one (60%) of these supplies complied with the legislative requirement for a pharmacist to supply the medicine. Voluntary recording was surmised to have been utilised 13 times (13% CCA supplies). CCAs were supplied less frequently in 2017 DPR scenarios compared to 2016 DPR scenarios (64% vs 86%; p = 0.024), and a greater proportion of 2017 DPR supplies were compliant with the legislative requirement of pharmacist supply (72% vs 46%; p = 0.041). No difference in proportion of sales surmised to have been voluntarily recorded was observed between the years. Interactions involving pharmacists resulted in less frequent supply of codeine than those without (58% vs 82%; p = 0.012). CONCLUSION: Mandatory legislative regulation of pharmacist supply of non-prescription codeine was more likely to be complied with than voluntary recording. Compliance with pharmacist supply for DPRs appeared to improve following the announcement of regulatory change to prescription-only, whereas voluntary recording of supply did not appear to change.


Asunto(s)
Analgésicos Opioides/provisión & distribución , Codeína/provisión & distribución , Servicios Comunitarios de Farmacia/estadística & datos numéricos , Medicamentos sin Prescripción/provisión & distribución , Analgésicos Opioides/administración & dosificación , Australia , Codeína/administración & dosificación , Servicios Comunitarios de Farmacia/legislación & jurisprudencia , Servicios Comunitarios de Farmacia/organización & administración , Combinación de Medicamentos , Humanos , Medicamentos sin Prescripción/administración & dosificación , Simulación de Paciente , Farmacéuticos/legislación & jurisprudencia , Farmacéuticos/organización & administración , Rol Profesional
11.
Int J Drug Policy ; 74: 170-173, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31622949

RESUMEN

PURPOSE: In February 2018, Australia up-scheduled the 'weak' opioid codeine to a prescription only medication. This study aimed to analyse the change in prescribing trends for codeine and other commonly prescribed opioids in Australia following this policy change to determine if removal of over-the-counter codeine resulted in an increase in opioid prescribing. METHODS: Data was obtained through the Australian Government Department of Human Services statistics website, and contained monthly data about subsidised national prescription numbers for codeine, oxycodone, oxycodone-naloxone, tapentadol, tramadol, morphine, and fentanyl, from January 2016 to December 2018. Segmented linear regression accounting for autocorrelation was used to assess the effect of codeine rescheduling on the supply trends of these opioids. RESULTS: Rescheduling codeine to remove over-the-counter (non-prescription) supply does not appear to have had an immediate effect on the prescription rates of codeine, and there is no significant change in these rates in the months following. Analysis of data showed decreasing trends for codeine and most other schedule 8 prescription opioids, with no increase in any prescribed opioids associated with codeine up scheduling. CONCLUSIONS: Despite concerns, substitution of over-the-counter codeine with higher strength prescribed codeine has not been observed at a population level, nor has a shift to other prescribed opioids occurred. Overall, opioid prescribing in Australia has been decreasing since 2016, both for strong and weak opioids.


Asunto(s)
Analgésicos Opioides/administración & dosificación , Codeína/administración & dosificación , Medicamentos sin Prescripción/administración & dosificación , Pautas de la Práctica en Medicina/estadística & datos numéricos , Analgésicos Opioides/clasificación , Australia , Codeína/clasificación , Humanos , Medicamentos sin Prescripción/provisión & distribución , Medicamentos bajo Prescripción/administración & dosificación , Estudios Retrospectivos
12.
Int J Drug Policy ; 73: 121-128, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31654934

RESUMEN

BACKGROUND: Dependence on over-the-counter (OTC) codeine is recognised internationally as a rising public health issue. The effectiveness of health intervention strategies may be influenced by the beliefs held by those who are dependent. Applying Q methodology, this study aimed to identify shared accounts of OTC codeine dependence. METHODS: Twenty-six participants from Tasmania, Australia, met eligibility criteria for the study as long-term OTC codeine users with a Severity of Dependence Score of five or higher. Forty-six opinion statements about OTC codeine dependence were sourced from the literature and online discussion forums. These were rank-ordered by participants from least to most agree and explanatory comments for the most strongly positioned statements were provided. By-person factor analysis was used to group participants who had sorted the statements similarly. RESULTS: Two distinct accounts of OTC codeine dependence were identified. Participants representing Factor One, 'For pain, no shame', were not ashamed of their OTC codeine use, believed access should not be restricted and regarded it as necessary for the relief of physical pain. In contrast, Factor Two, 'My secret solace', was characterized by feelings of guilt and shame. Participants in this group intentionally used codeine for its effects on mood; to help them relax and to relieve stress, rather than solely for pain relief. They did not consider regular use of codeine to be socially acceptable and hid their use from others. CONCLUSION: The way in which OTC codeine use is viewed by those who are dependent is not uniform. Two distinct accounts were identified in this sample. Participants from each group varied in their beliefs about access, causality, reasons for use and feelings of legitimacy and shame. An understanding of these differences can be used to better target interventions and guide policy for the prevention and management of OTC codeine dependence.


Asunto(s)
Codeína/administración & dosificación , Medicamentos sin Prescripción/administración & dosificación , Trastornos Relacionados con Opioides/epidemiología , Dolor/tratamiento farmacológico , Adulto , Codeína/efectos adversos , Femenino , Culpa , Humanos , Masculino , Persona de Mediana Edad , Medicamentos sin Prescripción/efectos adversos , Trastornos Relacionados con Opioides/psicología , Dolor/psicología , Vergüenza , Encuestas y Cuestionarios , Tasmania
13.
J Am Pharm Assoc (2003) ; 59(6): 852-856, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31501006

RESUMEN

OBJECTIVE: This study used an innovative information-gathering approach to provide insight into the nature and structure of pharmacy staff encounters with patients seeking over-the-counter (OTC) medications and revealed specific activities of pharmacy staff around these encounters. METHODS: A multistep process was used to develop and standardize an 8-item OTC Encounter Form to document the characteristics of pharmacy staff-patient encounters. The OTC Form contained several domains, including topics discussed and the problems or symptoms identified during the encounter, staff functions during the encounter, and approximate time spent with the patient. Nine pharmacists and 8 technicians used the OTC Form to document patient encounters over 7 consecutive days. Frequency distributions for each OTC Form item are reported. RESULTS: One hundred eleven OTC Forms were completed. Adults aged 65 years or older were involved in 46% of all encounters. Pharmacists provided the only assistance in 41% of encounters and worked in partnership with other pharmacy staff for another 25% of encounters. Many encounters required the pharmacy staff to leave the prescription department, involved discussions about a variety of problems or symptoms, and lasted less than 3 minutes. Although the most prevalent encounter topic was locations of a particular product, about one-third of encounters involved either recommendations about a product or providing information about a product, and 41% involved communications about 2 or more topics. Finally, 11% of encounters generated a nondrug recommendation, and 8% resulted in a referral to a physician. CONCLUSION: Pharmacists play a key role in ensuring that the benefits of OTC medications outweigh the risks, thereby providing an important resource for patient engagement about safe medication selection and use. Examining the features of OTC encounters creates an evidence base to promote best practices for OTC encounters, increasing pharmacists' ability to help people, especially older adults, navigate the intricacies of OTC medication use, without significantly increasing pharmacy staff workload.


Asunto(s)
Servicios Comunitarios de Farmacia/organización & administración , Medicamentos sin Prescripción/administración & dosificación , Farmacéuticos/organización & administración , Técnicos de Farmacia/organización & administración , Adolescente , Adulto , Anciano , Niño , Humanos , Persona de Mediana Edad , Rol Profesional , Derivación y Consulta/estadística & datos numéricos , Adulto Joven
14.
Int J Clin Pharm ; 41(6): 1462-1470, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31529269

RESUMEN

Background Increasing role of community pharmacists sometimes demands the diagnoses of minor ailments using appropriate questioning skills and recommendation of over-the-counter medications to patients seeking self-care. Objective To evaluate community pharmacists' questioning and diagnostic skills of minor ailment complaints, and the appropriateness of medication(s) recommendations made. Setting One hundred and thirty-one community pharmacies in Ibadan, Nigeria. Method A cross-sectional survey employing pseudo-patient study method. The pseudo-patient visited 131 community pharmacies from June 2017 to January 2018 and complained of stomach ache. The conversation between the pharmacists and pseudo-patient were audio-taped and transcribed verbatim. Two criteria were used to evaluate the questioning skill of the community pharmacists. One of the criteria was developed by a six-membered panel and had 13 questions while the other contained five questions:-Who is it for? What are the symptoms? How long have the symptoms been present? Action taken? and Medication used.? Questioning skill of the community pharmacists was classified based on the median scores of these two criteria as: poor, moderate and optimal. The diagnoses made by the community pharmacists from the pseudo-patients complaints were compared with the expected diagnosis of uncomplicated gastric ulcer caused by the use of ibuprofen. Recommendations for the pseudo-patients minor ailment were also compared with the Nigeria standard treatment guideline. Main outcome measure Pharmacists' questioning skill, types of diagnosis made and appropriateness of medications recommended. Results The median scores for the questioning skill criterion containing 5 and 13 questions were 2 and 4, respectively; showing poor questioning skill. Differential diagnoses of gastric ulcer, dyspepsia, gastroesophageal reflux, and hyperacidity were made by 92 (67.4%) pharmacists but 3 (2.3%) correctly diagnosed the pseudo-patients' minor ailment as uncomplicated gastric ulcer caused by short-term use of ibuprofen. Antacids were recommended in line with the standard treatment guideline by 46 (35.7%) pharmacists while proton pump inhibitors were recommended by 6 (4.7%) pharmacists. None advised the withdrawal of the provocative factor according to the treatment guideline. Conclusion The questioning skill of the community pharmacists in this setting was poor. Few community pharmacists diagnosed the pseudo-patients' minor ailment correctly. Also, recommendations were mostly inappropriate compared with the standard treatment guideline.


Asunto(s)
Servicios Comunitarios de Farmacia/organización & administración , Simulación de Paciente , Farmacéuticos/organización & administración , Úlcera Gástrica/diagnóstico , Competencia Clínica , Estudios Transversales , Diagnóstico Diferencial , Femenino , Humanos , Ibuprofeno/efectos adversos , Masculino , Nigeria , Medicamentos sin Prescripción/administración & dosificación , Farmacéuticos/normas , Rol Profesional , Úlcera Gástrica/etiología , Úlcera Gástrica/terapia , Encuestas y Cuestionarios
15.
PLoS One ; 14(9): e0222972, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31557201

RESUMEN

Oral nutritional supplements (ONS) are multi-nutrient products used to increase the energy and nutrient intakes of patients. The aim of this study was to examine whether or not the adherence of patients varies according to their receiving prescription or over-the-counter ONS. Data were obtained from an online cross-sectional survey conducted with patients in Japan. A total of 107 patients who matched the inclusion criteria for the prescription ONS group and 148 who matched the criteria for the over-the-counter ONS group were further analyzed. In the prescription and over-the-counter ONS groups, the main medical reason for ONS consumption were "malnutrition" (48 patients [44.9%] vs. 63 patients [42.6%] p = 0.798], "frailty" (29 patients [27.1%] vs. 36 patients [24.3%] p = 0.663) and "aging" (25 patients [23.4%] vs. 30 patients [20.3%] p = 0.644). The proportion of "No particular disease" for prescription ONS consumption was significantly lower than that for over-the-counter ONS (6 patients [5.6%] vs. 24 patients [16.2%] p = 0.001). The body mass index of the prescription ONS group was significantly higher than that of the over-the-counter ONS group (21.1±4.38 kg/m2 vs. 19.9±3.75 kg/m2, p = 0.0161). In the prescription ONS group, all patients were given medical advice by doctors or registered dietitians. In contrast, in the over-the-counter ONS group, only 46 patients (31.1%) were given advice by doctors or registered dietitians (p<0.001). In the prescription ONS group, ONS was taken significantly more times and for a longer duration than in the over-the-counter ONS group (p<0.0001). However, among patients given advice by doctors or registered dietitians, there were no significant differences between the groups. Greater support by the medical team is still needed in order to maximize adherence to supplementation, especially concerning the calories, timing and period, so that benefits can be achieved and sustained.


Asunto(s)
Suplementos Dietéticos/estadística & datos numéricos , Desnutrición/tratamiento farmacológico , Pacientes Ambulatorios/estadística & datos numéricos , Cooperación del Paciente/estadística & datos numéricos , Administración Oral , Anciano , Estudios Transversales , Prescripciones de Medicamentos/estadística & datos numéricos , Femenino , Humanos , Japón , Masculino , Persona de Mediana Edad , Medicamentos sin Prescripción/administración & dosificación , Medicamentos bajo Prescripción/administración & dosificación , Encuestas y Cuestionarios/estadística & datos numéricos
16.
Can J Urol ; 26(4): 9821-9828, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31469636

RESUMEN

INTRODUCTION: Treatment for lower urinary tract symptoms (LUTS) is often delayed, as it is considered a natural progression of aging. We described baseline demographic and clinical characteristics of men currently not using prescription medications for benign prostatic hyperplasia (BPH) but interested in self-directed use of over-the-counter (OTC) tamsulosin and who had participated in OTC tamsulosin-simulated studies. MATERIALS AND METHODS: Pooled baseline data from four OTC tamsulosin-simulated studies were analyzed for men who were currently not using BPH prescription medication and who believed that OTC tamsulosin was appropriate for use or were interested in purchasing it. Data from the OTC-simulated studies for men using BPH prescription medication and from the BPH registry, which included men diagnosed with BPH, were used for comparison. RESULTS: Overall, 3285 non-prescription-using men (mean age +/- standard deviation [SD], 60.6 +/- 11.6 years) were included. Average American Urological Association Symptom Index (AUA-SI) total score was 17.6; 25.5% reported urinary symptoms for > 5 years. Overall, 46.7% of these men had > 1 visit/year with their physicians. Baseline characteristics of prescription users from the OTC-simulated studies (n = 364; mean age ± SD, 68.3 +/- 9.1 years; mean AUA-SI score, 18.5) and of men from the BPH registry (n = 5042; 64.8 +/- 10 years; 11.6) were similar to those of non-prescription users. CONCLUSIONS: Non-prescription users had long term moderate-to-severe male LUTS, yet remained untreated; self-management may be a viable alternative strategy for this population. Disease characteristics of men not using BPH prescription medication and interested in using OTC tamsulosin were similar to those using BPH medication or diagnosed with BPH.


Asunto(s)
Antagonistas de Receptores Adrenérgicos alfa 1/administración & dosificación , Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Medicamentos sin Prescripción/administración & dosificación , Hiperplasia Prostática/complicaciones , Automanejo/métodos , Tamsulosina/administración & dosificación , Anciano , Humanos , Síntomas del Sistema Urinario Inferior/etiología , Masculino , Persona de Mediana Edad , Satisfacción del Paciente/estadística & datos numéricos , Proyectos Piloto , Estudios Prospectivos , Hiperplasia Prostática/diagnóstico , Medición de Riesgo , Resultado del Tratamiento , Estados Unidos , Retención Urinaria/tratamiento farmacológico , Retención Urinaria/etiología
17.
Artículo en Inglés | MEDLINE | ID: mdl-31346460

RESUMEN

Background: Dispensary and use of antibiotics without prescriptions from qualified providers is a common practice in countries with poor pharmaceutical regulations and where due focus is not given to rational use. This practice is a main factor for the spread of antimicrobial resistance due to its non-reliance on pre-treatment microbiologic work-up, improper indications and dosing errors. This study was conducted to determine the rate of over-the-counter dispensary of antibiotics for common childhood illnesses among privately owned medicine retail outlets in Addis Ababa, Ethiopia. Methods: Pre-determined simulated patient visits depicting common childhood illnesses were employed to request antibiotics without prescriptions. A simple random sampling was used to select medicine retail outlets within Addis Ababa city. Trained data collectors filled structured data forms (including antibiotic requested, reasons for denial of dispense and details enquired by pharmacist) shortly after each patient enactment. Multi-variable logistic regression analysis was employed to explore factors associated with over-the-counter sales of antibiotics. Results: A total of 262 simulated encounters were surveyed. Of the 262 verbal antibiotic requests, 63.4% were dispensed. Close to 60% of encounters were accompanied by questions about a doctor's visit or the child's symptomatology while a past history of drug allergies was enquired in only 11.1% of visits. Over-the-counter dispensary was more likely when dispenser queried about symptoms was made (AOR: 2.412, 95%CI: 1.236, 4.706), for requests for more than one antibiotics (AOR: 2.988, 95%CI: 1.258, 7.095) and for simulated patient demands for oral antibiotics for children with acute diarrhea (AOR: 3.297, 95%CI: 1.248, 8.712) and parenteral antibiotics for those reported to receive in-patient care for pneumonia (4.516, 95% CI: 1.720, 11.857). Conclusions: The prevalence of providing antibiotics over-the-counter for pediatric illnesses in Addis Ababa is markedly high. Further studies into factors encouraging this malpractice are required. Enhancing education of personnel dispensing antibiotics and strict enforcement of national regulations are needed.


Asunto(s)
Antibacterianos/administración & dosificación , Diarrea/tratamiento farmacológico , Medicamentos sin Prescripción/administración & dosificación , Prescripciones/estadística & datos numéricos , Antibacterianos/uso terapéutico , Niño , Simulación por Computador , Estudios Transversales , Etiopía , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Medicamentos sin Prescripción/uso terapéutico , Farmacias , Farmacéuticos , Sector Privado , Estudios Prospectivos
18.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(5): 554-558, 2019 May 10.
Artículo en Chino | MEDLINE | ID: mdl-31177737

RESUMEN

Objective: To understand the relationship between medication during pregnancy and single live preterm birth of infant in women of childbearing age in Shaanxi province. Methods: A cross-sectional design was used in this study and stratified multistage random sampling method was used. A questionnaire survey was conducted in the childbearing-aged women selected through multi stage stratified random sampling in Shaanxi during 2010 to 2013. Qualitative datum was described by percentage and measurement datum was described by mean±standard deviation. Logistic regression analysis was done to evaluate the relationship between medication during pregnancy and preterm birth of infant. Results: The overall incidence rate of premature birth was 2.7% in Shaanxi. Among the 28 841 mothers participating in this study, the proportion of medication use at any time during pregnancy was 15.8%, and the most commonly used drug was cold medicine (5.9%). After adjusting all confounding factors, the multivariable logistic regression analysis results showed that taking hormone medicine (OR=2.23, 95%CI: 1.19-4.18), antihypertensive medicine (OR=7.74, 95%CI: 4.28-13.95) and other medicines (OR=2.15, 95%CI: 1.60-2.89) during early pregnancy were the risk factors for preterm delivery, the risk was 2.23 times, 7.74 times and 2.15 times higher compared with those taking no these medicines. Conclusion: Using hormone medicine, antihypertensive medicine and other medicines during pregnancy increased the risk for preterm delivery in women of childbearing age in Shaanxi.


Asunto(s)
Medicamentos sin Prescripción/administración & dosificación , Complicaciones del Embarazo/epidemiología , Nacimiento Prematuro/epidemiología , Medicamentos bajo Prescripción/administración & dosificación , Antihipertensivos/administración & dosificación , Antihipertensivos/efectos adversos , China/epidemiología , Estudios Transversales , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Madres , Medicamentos sin Prescripción/efectos adversos , Embarazo , Medicamentos bajo Prescripción/efectos adversos , Factores de Riesgo
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