Household Pharmaceutical Waste Disposal as a Global Problem-A Review.

The negative effect of the pharmaceuticals presence (persistence?) in various components of the environment is a global problem today. These compounds are released into the environment as a result of, inter alia, their use and improper disposal. Therefore, it is important to reduce excessive drug consumption and to develop a system for the collection of unused/expired pharmaceuticals. The effectiveness of actions in this area is inextricably linked with the need to educate society on how to deal properly with unwanted medications. The aim of the study was to show that the inappropriate handling of unused/expired drugs by society is an important problem in waste management systems, and it impacts the state of the environment. Forty-eight scientific articles published between 2012 and 2021 were taken into account that discussed the systems in various countries for the collection of unused/expired pharmaceuticals. This literature review shows that the main method of disposing of unused/expired medications, according to respondents from different countries, is either by disposing of them in household waste or flushing them into the sewage system. This is also the case in countries with systems or programs for the return of redundant drugs, which indicates that these systems are not sufficiently effective. This may be influenced by many factors, including the lack or ineffective education of the society.

Access to Health Information in the Polish Healthcare System-Survey Research.

Progress in medicine, transformations in healthcare organisation systems and access to new technologies have contributed to many changes in relations and communication between patients and healthcare personnel. The time to discuss and clarify doubts has shortened, while the period of waiting for an appointment and a consultation with a specialist has often been prolonged. Due to the lack or misunderstanding of information obtained from medical professionals, many people seek health information on their own account. The purpose of this document is to analyse the access Polish patients have to health information, the sources of and reasons for seeking that information, as well as the degree to which patients are satisfied with the information they find. We will also examine cases where patients choose self-healing. This is a survey based on an original questionnaire. The survey was conducted online and offline. The results of the survey were analysed by use of descriptive statistics. The analysis has indicated that access to health information is a universal need, which is independent of gender, age or education. Health information obtained from a doctor is most desired. The second-best source of information chosen by respondents is the Internet. Family members and friends are indicated as the third information source. Polish patients greatly appreciate doctors as a source of health information; however, given the difficulties connected with gaining direct access to information from healthcare personnel, they often search non-professional sources for information. The Internet and other media may be tools supporting the establishment of a safety culture, provided that the content published therein is consulted with medical professionals.

Extended Prescribing Roles for Pharmacists in Poland-A Survey Study.

BACKGROUND: In recent years, a systematic increase in the role and powers of pharmacists has been observed. The COVID-19 pandemic has shown that this is a professional group that is extremely necessary for the smooth functioning of the health care system. One of the important powers of pharmacists is the possibility of issuing prescriptions for both patients in the pharmacy and for themselves and their family members. Polish pharmacists obtained extended entitlements in this field in March 2020. Due to the extension of pharmacists' prescribing rights in Poland, it was decided in this study to determine the current practice of pharmaceutical prescribing, and pharmacists' views on their new duties. METHODS: The study used the method of a questionnaire, which was distributed to all pharmacists actively working in Poland. During the study, 309 completed questionnaires were obtained that gathered information about prescriptions written by pharmacists, as well as their opinions related to this entitlement. The results of the survey were analyzed using descriptive statistics. RESULTS: Out of all authorized pharmacists, 75.62% use the new, extended authorization to issue pharmaceutical prescriptions. About half of them believe their prescriptions should be refundable. Only 11.52% of respondents do not use the entitlement to issue prescriptions for themselves or their family members. In addition, it was noticed that those who write such prescriptions most often use the fully paid version. CONCLUSIONS: Polish pharmacists use the new entitlements willingly but carefully. The legal provisions governing electronic prescription should be clearer. In addition, the idea of continued prescription should be developed as this is the most common reason that pharmacists issue prescriptions.

Loneliness, Complaining and Professional Burnout of Medical Personnel of Psychiatric Wards during COVID-19 Pandemic-Cross-Sectional Study.

BACKGROUND: Professional burnout in the medical community has been present for a long time, also among mental health professionals. The aim of the study was to examine the links between loneliness, complaining and professional burnout among medical personnel in psychiatric care during a pandemic. Loneliness and complaining of the medical staff are not documented in the literature well enough. METHODS: Oldenburg Burnout Questionnaire, the Loneliness Scale, the Complaint Questionnaire and author's questionnaire. The respondents: 265 medical employees-doctors (19.2%), nurses (69.8%), paramedics (4.9%), medical caregivers (5.7%). RESULTS: Loneliness and complaining are significant predictors of exhaustion. The model explains 18% of exhaustion variance. Loneliness, complaining and job seniority are also predictors of disengagement; the model allows to predict 10% of the variance of disengagement. Women are more prone to complain. Complaining significantly correlates with direct support from management. A high rate of loneliness correlates, in a statistically significant way, with worse work organization, less management support, worse atmosphere in the team and with more irresponsible attitudes of colleagues. CONCLUSIONS: Loneliness and complaining can be used to predict occupational burnout. Women and people without management support complain more often. Loneliness is connected with bad work organization and bad cooperation in a team.

Assessment of Pharmacists Prescribing Practices in Poland-A Descriptive Study.

Pharmacists play a beneficial role in supplying medicines to patients. Pharmacist prescribing practices were introduced into law in Poland in 2002, permitting pharmacists to prescribe medications in emergency situations and in 2020 the new law allowed to prescribe in all situation where it is needed because of the health risks reasons. Our aim was to analyze pharmacist prescribing practices in Poland and confirm the useful of pharmacists' activity in this area. Additionally, pharmacists were also authorized to issue reimbursed prescriptions for themselves or their family members. Since January 2020, only e-prescriptions are allowed in Poland. A retrospective analysis of the inspection written reports from 842 community pharmacies in the representative region of Poland with a population of two million, carried out in the time period from 2002 to 2016 was performed (2189 prescriptions) to assess the emergency pharmacist prescribing practices in Poland. The second part of the research was based on digital data on pharmacists prescriptions (18,529) provided by the e-Health Centre (a governmental organization under the Ministry of Health responsible for the development of health care information systems in Poland), enabling to conduct the analysis of pharmacist's prescribing from 1 of April 2020 to 31 of October 2020. The analysis gave the insight of the evolution of the pharmacy prescribing patterns. In general, pharmaceutical prescriptions were issued in cities with more than 100,000 inhabitants, in town- or city center pharmacies, and in pharmacies in residential areas. The most common reason for a pharmaceutical prescription was that the patient was running out of a medicine and was unable to contact their physician. Cardiovascular, respiratory, dermatological, and digestive medications were most frequently prescribed. An analysis of pharmacists' prescribing data from 1 April 2020 to 31 October 2020 confirmed the rapid increase of pharmaceutical prescriptions following implementation of the new legislative act during the COVID-19 epidemic.

A Survey of Patients' Opinions and Preferences on the Use of E-Prescriptions in Poland.

E-prescription is already used in many countries, improving the standard of patient care. Officially, from 8 January 2020 e-prescribing has been obligated in Poland. Physicians' and pharmacists' opinions on e-prescribing have been widely researched and reported in the literature. In contrast, patients' perception has, to date, received little attention. For this reason, the aim of this study was to find the features and functionalities of e-prescribing that are desired by the public and influence the positive evaluation of this tool, according to patient opinion. In order to obtain data, a questionnaire was completed by 456 randomly selected adults. The obtained results indicated that only eight people (1.8%) did not know what e-prescription is. Of the remaining 448 individuals, 72.1% prefer e-prescription because it is more convenient for them. Most patients (62.1%) also recognize that e-prescribing makes it easier to purchase medications on behalf of another patient. Based on the study, it can be concluded that e-prescription is well evaluated by Polish patients. A large percentage of respondents were positive about obtaining prescriptions for continued treatment, without a personal doctor visit. Therefore, it is reasonable to maintain the possibility of such contact with a physician. The most popular, and preferred, method of receiving e-prescriptions is via SMS. However, it is necessary to offer different options for obtaining prescriptions, to meet the needs of different populations.

Written Informed Consent-Translating into Plain Language. A Pilot Study.

BACKGROUND: Informed consent is important in clinical practice, as a person's written consent is required prior to many medical interventions. Many informed consent forms fail to communicate simply and clearly. The aim of our study was to create an easy-to-understand form. METHODS: Our assessment of a Polish-language plastic surgery informed consent form used the Polish-language comprehension analysis program (jasnopis.pl, SWPS University) to assess the readability of texts written for people of various education levels; and this enabled us to modify the form by shortening sentences and simplifying words. The form was re-assessed with the same software and subsequently given to 160 adult volunteers to assess the revised form's degree of difficulty or readability. RESULTS: The first software analysis found the language was suitable for people with a university degree or higher education, and after revision and re-assessment became suitable for persons with 4-6 years of primary school education and above. Most study participants also assessed the form as completely comprehensible. CONCLUSIONS: There are significant benefits possible for patients and practitioners by improving the comprehensibility of written informed consent forms.

Doctors' Perceptions of E-Prescribing upon Its Mandatory Adoption in Poland, Using the Unified Theory of Acceptance and Use of Technology Method.

BACKGROUND: E-prescribing is the most important achievement in the automation of the healthcare sector in Poland. Obligatory electronic prescribing came into force on 8 January 2020. This innovation significantly changes the work of doctors. Therefore, it is useful to identify the factors that have an impact on doctors' acceptance levels for the new technology. METHODS: This study employs a survey based on the Unified Theory of Acceptance and Use of Technology (UTAUT) method. Our questionnaire was completed by 144 family doctors in Poland during the technology implementation phase and the initial period of obligatory e-prescribing, between 1 December 2019 and 1 March 2020. RESULTS: The results of the survey indicate that doctors do not believe that e-prescribing improves the effectiveness of their work. In addition, this attitude does not depend on the age of the respondent. We also found, regarding the influence of societal attitudes, that doctors only rarely consider the opinions of others in relation to their job. CONCLUSIONS: The implementation of new technologies in the healthcare system must be accompanied by consideration of how user-friendly the technologies are, and whether the users will have appropriate technical and financial support.

Drug-safety reporting in Polish nursing practice-Cross sectional surveys.

INTRODUCTION: Nurses play a significant role in ensuring the safety and quality of drugs. Our aim was to assess significant factors in nurses' participation in ensuring pharmacotherapy safety by reporting adverse drug reactions (ADR) and detecting substandard drugs (SD). MATERIALS AND METHODS: The study was a cross-sectional, comparative survey, using original questionnaires. Survey questions were grouped to probe the opinions, attitudes and practices of nurses reporting ADRs and SDs. Data were obtained from nurses working in teaching hospitals in Poland (group A) and, for comparison, in the USA (group B). 1200 questionnaires were distributed in Poland (return rate: 55.7%) and 200 questionnaires in the USA (return rate: 73%). Both groups were surveyed during the same period. There were no exclusion criteria. The questionnaires were self-administered. Distribution and collection were anonymous. Participation was voluntary. The Spearman correlation test was used. Both groups' responses were cross-tabulated and compared using Fisher's Exact Test for Count Data. RESULTS: The study group comprised 669 Polish and 146 American professionally active nurses working in general care and surgical departments. Age range: 18 to 72 years. Median job seniority: 18.3 years (group A) and 20.6 years (group B). Education levels varied. ADR reporting conditions in Poland are unfavorable: shortage of time-83.9% vs 22.6% in the US (p = 0.01); no incentive-58.2% vs 6.1% in the US (p = 0.01); and no equipment-44.7% vs 2.8% in the US (p < 0.01). Both Polish and American nurses indicate they rarely report SDs, with rates of 0.4% and 11% (p < 0.0001) respectively, during the study period. CONCLUSIONS: Nurses in Poland are insufficiently prepared to ensure drug safety conscientiously and responsibly. Training is required for Polish nurses. Nurses' employers need to improve conditions to enable reporting of ADRs and SDs.

Patient Safety Culture in EU Legislation.

Patient safety means a condition in which a patient does not suffer any unnecessary actual harm, nor is exposed to any potential harm related to healthcare. The World Health Organization's recognition of patient safety, as one of the most important factors in determining high quality healthcare, initiated the systematic introduction of changes in the approach to this issue, both globally and on the level of individual healthcare service providers. In order to enhance the quality and ensure the safety of healthcare services provided, national, European Union, and worldwide institutions focus on the introduction of a so-called patient safety culture. The creation of this safety culture would not be possible without the establishment of its legal framework. The purpose of this article is to shed light on the legislative achievements of the European Union within patient safety, taking into consideration acts that summarize the level of implementation of individual recommendations. This study can be useful both for those who focus their scientific interests on the subject of patient safety and those who need concise information on the legislative measures of the Community in this respect, as well as for medical personnel who want to become acquainted with this issue without reading comprehensive legal acts.

The Implementation Process of Nurse Prescribing in Poland-A Descriptive Study.

The study aimed to investigate the situation of nurse prescribing, introduced in Poland in 2016, by analyzing the opinions of nurses, expected to be influential on nurses' actual practices, in response to legislative change to enable nurses to prescribe and comparing this with actual nurse prescribing behaviours during the early years of the legislation. The paper fills a knowledge gap and provides baseline data analysis for subsequent research. Nurses' opinions were collected during the period they were preparing themselves for prescribing. That data was compared with data on the character and extent of nurses' actual prescribing practices over the first two years of implementation. The study showed the number of nurse prescriptions increased. Comparing the first and second years of nurse prescribing, the number of nurse independent prescriptions more than doubled. Over the same period, the number of nurse supplementary prescriptions increased almost six-fold. The implementation of nurse prescribing has increased the scope of nursing care, especially in the treatment of the infections, pain and chronic conditions in the elderly.

Pharmaceutical Household Waste Practices: Preliminary Findings from a Case Study in Poland.

Pharmaceutical consumption continues to grow constantly. Unused/expired pharmaceuticals are disposed of to the municipal sewage system or waste disposal. Consequently, many countries have implemented a system of collecting pharmaceutical waste, with pharmacies playing an important role. It is important to educate consumers on rational consumption and the appropriate disposal of unused/expired pharmaceuticals and to identify the level of public awareness. Two studies were conducted in Poland to estimate the problem of collection and disposal of expired/unused pharmaceuticals. The purpose of the Survey I was to identify the scale of pharmaceutical consumption and the way pharmaceuticals are disposed of by various social groups. The Survey II was aimed to identify patients' attitudes regarding expired/unused pharmaceuticals at home. Of the respondents who participated in in Survey I, almost 74% indicated that analgesics were among the over-the-counter drugs they purchased. Group of pharmaceuticals 65% of the respondents purchased were medicines for treating flu symptoms. Almost 68% of the respondents said they usually disposed of expired pharmaceuticals in their household waste or by flushing them down the toilet. In Survey II more than 35% reported that they disposed of pharmaceuticals in the same ways. Of all respondents, ~30% returned their expired pharmaceuticals to pharmacies. Most respondents (over 65%) who participated Survey I indicated that they were aware that pharmaceutical waste can be returned to pharmacies. It should be noted that local governments are currently not obliged by law to work with or compensate pharmacies in the collection and proper disposal of unused pharmaceuticals.

[Cytostatic and cytotoxic waste - rules of conduct in Poland]. / Odpady cytostatyczne i cytotoksyczne ­ zasady postepowania w Polsce.

Poland is one of the European countries with the highest level of production of dangerous medical waste. Although in Europe the volume of produced cytotoxic and cytostatic waste (used in chemotherapy by oncological patients) has been declining for several years, in Poland a reverse trend has been observed. As this waste puts the safety of medical workers and patients at risk, special handling procedures are required to limit the harmful effect of these drugs on human health. In view of the above, the aim of the work was to present the rules of conduct with cytotoxic and cytostatic drugs, and their waste, in Poland. Med Pr. 2019;70(3):377-91.

RX-TO-OTC SWITCH AND DOUBLE REGISTRATION OCCURRENCE IN POLAND--AN ILLUMINATIVE CASE STUDY.

Rx-to-OTC switch is a global occurrence, which aims to promote patients' responsible self-treatment of minor ailments. Many countries could benefit from such self-treatment and reduce their rising health care costs by allowing citizens to avoid the need for a physician's consultations. What must be noted however, is that the inappropriate use of over-the-counter medicines can have also a darker side. Potential problems arising from OTC use might include: increased costs of treating complications resulting from not proper use or abuse, or possible interactions with the other medications, that patients take for chronic diseases. To maintain the desired level of patient safety, relieving one working group (the medical profession) from an existing obligation should be associated with the need for increased involvement and/or authorizations from other working groups. Professional pharmacists are already globally recognized as being trained in the field of health condition assessment. This paper presents an objective case study of current pharmaceutical law and thus, may serve as a starting point for an responsible discussion regarding the institution of a new class of drugs understood as pharmacist-only.

ADVERSE DRUG REPORTING IN COMMUNITY PHARMACY PRACTICE IN THE POMERANIAN DISTRICT IN POLAND.

The changing role of the modern pharmacies involves reporting adverse drug reactions (ADR's). The aim of the study is to investigate the knowledge of community pharmacy professional staff (PS) about the new pharmacovigilance (PG) legislation and to analyze patients' attitudes towards the community pharmacy role in PG across north central region in Poland. Research material was collected in a group of pharmacy PS and patients from January 2014 to August 2014 in the Pomeranian District. A cross-sectional study was conducted. The research project consisted of three single anonymous surveys. Main outcome measure was knowledge of PS towards ADRs reporting, attitudes of patients towards ADRs in relation to PS in a community pharmacy. Over half of surveyed pharmacists (54.7%) and only 13% of pharmaceutical technicians know the correct and current definition of ADR. PS do not know what kind of ADRs should be reported - only 41% of pharmacists and 12.1% of technicians presented adequate knowledge. As far as the knowledge of where to notify is concerned - it was present in 60.7% of pharmacists and only 11.2% of pharmaceutical technicians. In most cases pharmacists (72%) know that patients can make their own notifications, technicians showed such knowledge only in 37.4% of cases. Patients who detect an ADR occurrence often do not transmit the information (19% of respondents). However, if they decide to report, they mostly talk to physicians (76.6%), and, less frequently (14.6%), to pharmacy PS. In the opinion of patients, however, the pharmacy PS (20.3%) are identified as sub- jects involved in reporting ADRs and those who can transmit information on the ADRs. The results suggest that pharmacists' knowledge of the rules of reporting ADRs is superior to that of pharmaceutical technicians. In fact, PS are not sufficiently prepared for reporting ADRs. Patients, in turn, do not have adequate awareness of reporting the observed ADRs. They, however, associate the community pharmacy with PG system, although the extent is unsatisfactory. In this regard, a more effective training of PS would be recommended along with tailored social campaigns to inform about the PG system in Poland.

[Diagnostic imaging of lying]. / Obrazowanie diagnostyczne klamstwa.

Functional diagnostic imaging has been applied in neuropsychology for more than two decades. Nowadays, the functional magnetic resonance (fMRI) seems to be the most important technique. Brain imaging in lying has been performed and discussed since 2001. There are postulates to use fMRI for forensic purposes, as well as commercially, e.g. testing the loyalty of employees, especially because of the limitations of traditional polygraph in some cases. In USA fMRI is performed in truthfulness/lying assessment by at least two commercial companies. Those applications are a matter of heated debate of practitioners, lawyers and specialists of ethics. The opponents of fMRI use for forensic purposes indicate the lack of common agreement on it and the lack of wide recognition and insufficient standardisation. Therefore it cannot serve as a forensic proof, yet. However, considering the development of MRI and a high failure rate of traditional polygraphy, forensic applications of MRI seem to be highly probable in future.

Restrictions on the reimbursement policy with regard to retail marketing of medicinal products in Poland.

On January 1, 2012, the law of 12 May 2011 on the reimbursement of medicines, food products of special nutritional purpose and medicinal products, intended to tighten up the reimbursement system, came into force in Poland. The new legislative act has significantly altered the previous principles of retail marketing of products subject to publicly financed reimbursement. First of all, the prices of reimbursed products have been unified through the introduction of fixed margins and prices and a ban--completely unknown until now--on using free market sales practices. These regulations are intended to lead to the abolition of price competition and its replacement with competition as to the quality of services provided by pharmacies. At the same time, entities engaged in retail marketing of medicinal products have been imposed a number of new obligations and highly repressive penalties for failure to fulfill them. The paper analyzes the legislative changes and points out the consequences, both those which can already be seen and the predictable ones. The assumed priority and criterion of evaluation of the reimbursement policy in question is its impact on the functioning of pharmacies which, according to the premises of Polish pharmaceutical law, should play the role of public health protection institutions.

Tuberculosis in the course of sarcoidosis treatment: is genotyping necessary for personalized therapy?

Pathological similarities between sarcoidosis (SA) and tuberculosis (TB) suggest that mycobacterial antigen(s), in genetically different predisposed hosts, may be a cause of SA. The authors' work and other published comparative analyses of HLA and non-HLA alleles in patients with SA or TB from different ethnic groups in the world revealed that some antigens were connected with high risk of SA or TB development, but others were comparable in both patient populations. The authors also showed a possibility of predominant occurrence of HLA alleles characteristic for TB as a cause of TB in patients with SA on corticosteroid therapy. It is possible that an analysis of SA and TB patient's genetic background may be helpful for protection from TB in SA patients on corticosteroids, especially on anti-TNF-α treatment. The authors suggest that the consideration of an immunosuppressive therapy in SA patients will need more attention and individual therapy based on genotyping study.

[Influence of low-molecular-weight heparin on the life quality of patients after intravascular medical procedures in comparison to patients who were treated with oral anticoagulants]. / Wplyw stosowanych heparyn drobnoczasteczkowych i doustnych antykoagulantów na jakosc zycia chorych po przebytych zabiegach wewnatrznaczyniowych.

UNLABELLED: Atherosclerosis is the illness of arteries which causes changes in vessels leading to their narrowing and then to their closure. Men are mainly attacked by illnesses of arteries. There are several factors which can intensify these illnesses such as: diabetes, smoking cigarettes, diet rich in cholesterol, arterial hypertension. Chronic ischemia of lower extremities is the most frequent illness with which patients notify. Patients with long-standing atherosclerotic process are usually afflicted with thrombotic ischemia. The life quality is the term that can have many meanings. It can be treated objectively or subjectively. In the first case we deal with the quality of life and in the second one with the feeling of life quality. Considering the problem we can base on the level of fulfilling the norm or on riches of obtained experience. The term life quality is significantly connected with the process of cognitive assessment of the individual. The quality of life of patients who were subjected to intravascular medical procedures considerably changes. The continuation of surgical treatment is pharmacotherapy which is connected with administering to patients low-molecular-weight heparin or oral antithrombotic medicine. The aim of the study was an evaluation of quality of life of patient after intravascular medical procedures, at which continued treatment was low-molecular-weight heparin and comparison of received results with subjective feeling of quality of life among ill across passing, treated oral anticoagulants medicines. MATERIAL AND METHODS: A number of 50 patients participated in the research. The most numerous group was made up of people aged 51-60 (20 people, 40%), 15 patients (30%) were over 61 years old, 7 ill (14%) were aged 41-50, 5 people (10%) were aged 31-40 and 3 patients (6%) were aged 20-30. Tested patients were selected randomly. The largest number of people (54%) came from the cities with more than 50 thousand inhabitants. People living in the towns with less than 50 thousand inhabitants made up a bit smaller group (30%). A questionnaire of pain assessment according to the NRS scale was used in the research (from 1 to 10; 1 means: "I do not feel pain", 10: "unbearable pain") as well as EuroQol 4D--a questionnaire of health state and quality of life assessment. The questionnaire consisted of 20 questions and was filled in voluntarily. RESULTS: Conducted research has shown that the life quality of patients who were treated with low-molecular-weight heparin changed for better in higher degree than patients who were treated with oral antithrombotic medicine.

Selected aspects of europeization of pharmaceutical law.

As one of its aspects, the process of European integration has an influence on the legal orders of the Member States, which is often referred to in the literature as the europeization of law. Upon Poland's accession to the structures of the European Union, there have also been radical changes to the Polish legal system. According to the concept of the sources of law in the Polish Constitution and to the judicial decisions of the European Court of Justice, Community law now takes priority over national law, even over acts of parliament. Pharmaceutical law represents one of the areas where the harmonization process has been taking place. It shapes the principles and the manner according to which medicinal products are approved for marketing, the conditions of clinical trials, as well as the conditions of drug manufacture and advertisement. It also determines the rules of trading in medicinal products, the running of pharmaceutical wholesalers and pharmacies, as well as the duties and rights of the Pharmaceutical Inspectorate. This paper provides a summary of research on the impact of Community law on Polish pharmaceutical law, i.e. on the europeization process, and on the consequences of this process for the Polish pharmaceutical market and for research and development.