Analysis of medication administration in relation to food and beverages in inpatients.

Proper medication administration in relation to beverage or food is one of the essential tools to achieve the pharmacotherapy goals. It is not known whether this is also considered in the care of inpatients. The aim of this study was to describe and analyse the current practice of medication administration in relation to food and beverages to patients hospitalized in four hospitals in the Czech Republic. This study was conducted based on the results of the first phase of a prospective observation study focused on the safety of medication administration performed by nurses. All data, including the timing of medication administration in relation to food and the data on beverages used, were obtained by the method of direct observation. The team of observersaccompanied the nurse during medication administration. The appropriateness of the medication administration in relationto food/beverages was assessed according to the summary of product characteristics and the published literature. In total, the administration of 5718 oral medications and 198 insulins were analysed. Unproper food timing wasobserved in 15.7% of oral medication administrations and 26.8% of insulin administrations. The highest number ofunproper food timing occurred in the proton pump inhibitors, antihypertensives, and prokinetics. Tea (63.4%) was the most used beverage. Errors with clinically serious impact have been observed in some groups of drugs. The necessity of a systemic approach in management of medication administration is required including interdisciplinary cooperation.

Pharmacotherapy as major risk factor of falls - analysis of 12 months experience in hospitals in South Bohemia.

This study aimed to analyze the effect of fall risk-increasing drugs (FRIDs) and drug-related factors relative to falls through clinical pharmacy service in hospitalized patients, focusing on the relevance of clinical pharmacist evaluation in the context of physician assessment. A prospective study of inpatient falls was conducted in 2017 retrieving data from 4 hospitals in South Bohemia, Czech Republic. An online database was developed to collect patient and fall-related data, and fall evaluation records. Healthcare professionals classified the overall effect of drugs on falls using Likert scale. Univariate and multivariate correlations were performed with a significance level of p < 0.05. Out of the total 280 falls (mean age of patients 77.0 years), a mean of 2.8 diagnoses with fall-related risk, 8.8 drugs, and 4.1 FRIDs per fall were identified. Incidence of falls decreased quarterly (p < 0.001). Use of FRIDs were positively associated with increasing age (p = 0.007). Clinical pharmacists were more likely to identify pharmacotherapy as the relevant fall-related risk, compared to physicians evaluation (p < 0.001). An increasing total number of prescribed drugs as well as higher number of FRIDs increased the suspicion in both professionals in the context of drug-related causes of falls.

Clinical pharmacist involvement in fall management in a polymorbid geriatric patient with a history of recurrent falls.

Patient falls represent a significant burden on healthcare facilities, particularly by prolonging hospitalization and increasing the cost of subsequent healthcare. In most cases, fall is caused by a combination of several modifiable and unmodifiable risk factors. The pharmacotherapy, which is often unreasonably administered in relation to patient health condition and drug combination, belongs among the modifiable risk factors. In this case report, the potential effect of pharmacotherapy on the patient fall-related risk as well as clinical pharmacy service that can contribute to reducing the risk of falls by engaging of clinical pharmacist in a multidisciplinary team with focus on the risks of pharmacotherapy and their management are shown.

The plausible association of MTHFR and ADORA2A polymorphisms with nodules in rheumatoid arthritis patients treated with methotrexate.

OBJECTIVE: The treatment of rheumatoid arthritis (RA) patients with methotrexate (MTX) is linked to the development or progression of rheumatoid nodules. The aim of this study was to determine whether folate and adenosine pathways-related single nucleotide polymorphisms might be predictive of increased nodule formation in RA patients treated with oral MTX. METHODS: A total of 185 Caucasian RA patients were enrolled in this cross-sectional study, all of whom fulfilled the 1987 RA criteria of the American College of Rheumatology; each patient had a history of MTX treatment. RESULTS: A higher frequency of the MTHFR 1298AA genotype was found in 17 (70.8%) of 24 patients with general nodules [odds ratio (OR)=3.08, 95% confidence interval (CI): 1.20-7.69] and in 14 (73.7%) of 19 patients who developed nodules during MTX treatment (OR=3.55, 95% CI: 1.22-10.32). In contrast, a negative association with nodules during MTX treatment (OR=0.29, 95% CI: 0.08-1.10) was found for 19 (79.2%) patients with the TT genotype (rs2298383) in the adenosine A2a receptor gene (ADORA2A). However, the significance did not remain upon correction for multiple testing. The combination of MTHFR 1298AA along with ADORA2A rs2298383 CC or CT genotypes occurring in one-third of RA patients showed a higher frequency of general nodules 15/59 (25.4%) as well as developing nodules during MTX treatment 13/59 (22.0%) in comparison with the overall studied group: 24/185 (13.0%) and 19/185 (10.3%), respectively. CONCLUSION: This exploratory study indicates for the first time a plausible association of adenosine and folate pathways single nucleotide polymorphisms in nodules' etiopathogenesis.

A Randomized, Placebo-Controlled Phase 2 Trial of CNTO 6785 in Chronic Obstructive Pulmonary Disease.

Interleukin (IL)-17A may be an underlying factor in the pathophysiology of chronic obstructive pulmonary disease (COPD). Anti-IL-17 monoclonal antibodies have been used successfully in treating several immune-mediated inflammatory diseases. This phase 2, randomized, placebo-controlled, double-blind, parallel-group, proof-of-concept study is the first clinical study evaluating the efficacy and safety of the anti-IL-17A monoclonal antibody CNTO 6785 in patients with symptomatic moderate-to-severe COPD. Patients were treated with CNTO 6785 (n = 93) or placebo (n = 94) intravenously at Weeks 0, 2, and 4 (induction), then Weeks 8 and 12, and followed till Week 24. The primary efficacy endpoint was the change from baseline in pre-bronchodilator percent-predicted forced expiratory volume in 1 second at Week 16. Samples were collected at all visits for pharmacokinetic (PK) evaluation, and standard safety assessments were performed. The mean difference in the primary efficacy endpoint between CNTO 6785 and placebo was not statistically significant (-0.49%; p = 0.599). No other efficacy endpoints demonstrated clinically or statistically significant differences with CNTO 6785 compared with placebo. CNTO 6785 was generally well tolerated; no major safety signals were detected. The most frequently reported treatment-emergent adverse events were infections and infestations; however, no notable differences were observed between CNTO 6785 and placebo in terms of rates of infections. PK results suggested that the steady state of serum CNTO 6785 concentration was reached within 16 weeks. These results suggest that IL-17A is unlikely to be a dominant driver in the pathology of, or a viable therapeutic target for, COPD. ClinicalTrials.gov Identifier: NCT01966549; EudraCT Identifier: 2012-003607-36.

Genetic polymorphisms in metabolic pathways of leflunomide in the treatment of rheumatoid arthritis.

Leflunomide (LEF) is a disease-modifying anti-rheumatic drug used for treating rheumatoid arthritis (RA). More than 50% of patients are withdrawn from LEF treatment within one year, mainly due to AEs. Importantly, it is not possible to predict which patients will respond to LEF therapy nor if adverse outcome occurs. Pharmacogenetic studies indicate an impact of single nucleotid polymorphisms (SNPs) on the variability in LEF serum levels with potential relevance to effectiveness and tolerability in individual RA patients. In vitro studies have demonstrated that cytochromes P450 (CYPs), mainly CYP1A2, CYP2C19, and CYP3A4, are involved in LEF metabolite activation. It was shown that CYP1A2*1F allele may be associated with LEF toxicity in patients with RA. In case of dihydroorotate dehydrogenase (DHODH) gene SNP (rs3213422, 19C>A), it was shown that C allele may be associated with LEF toxicity and therapeutic effect. Finally, oestrogen receptor genes SNPs in females may be associated with LEF therapy efficacy. In summary, the results of the current studies suggest a possible diagnostic value of genotyping for patients with RA as biomarkers of LEF therapy efficacy or conversely as indicators of serious side effects. In the future, it will be necessary to corroborate these results in studies with larger numbers of patients and longer follow-up. Moreover, it would be appropriate to focus on CYP2C19, ATP5A1 and PKD1L3 genes.

The impact of C677T and A1298C MTHFR polymorphisms on methotrexate therapeutic response in East Bohemian region rheumatoid arthritis patients.

Some single-nucleotide polymorphisms (SNPs) might be predictive of methotrexate (MTX) therapeutic outcome in rheumatoid arthritis (RA). The aim of this study was to determine whether SNPs in the methylenetetrahydrofolate reductase (MTHFR) gene are predictive of MTX response. Comparison was made using EULAR response criteria and according to the change of DAS28 (∆DAS28) after a 6-month MTX treatment in RA patient cohort. The two SNPs C677T (rs1801133) and A1298C (rs1801131) have been genotyped. A total of 120 patients were enrolled in the study, and all of them fulfilled the American College of Rheumatology 1987 RA criteria and are currently or previously taking MTX oral treatment, either as a monotherapy (n = 65) or in a combination with other disease-modifying antirheumatic drugs (n = 55). Genotyping was performed using qPCR allelic discrimination. We did not found any association of C677T and A1298C genotypes with MTX treatment inefficacy in dominant model (OR 1.23, 95 % CI 0.57-2.65, P = 0.697; and OR 0.98, 95 % CI 0.47-2.14, P = 1.0, respectively), or in recessive and codominant models. However, when ∆DAS28 after a 6-month therapy was used as a measure of treatment efficacy, the 677CT and 1298AC genotypes were found to be significantly associated with less favorable response to MTX (P = 0.025 and P = 0.043, respectively). In addition, even lower ∆DAS28 was determined for double-mutated 677CT-1298AC heterozygotes. It means that a synergistic effect of 677CT and 1298AC genotypes was observed. Nevertheless, the DAS28 baseline was lower here comparing to other genotypes. Unexpectedly, quite the opposite trend-i.e., better response to MTX-was found in genotypes 677CC-1298CC and 677TT-1298AA. It is an intriguing finding, because these double-mutated homozygotes are known for their low MTHFR-specific activity. Global significance was P = 0.013, η (2) = 0.160-i.e., large-size effect. Thus, our data show greater ability of 677CC-1298CC and 677TT-1298AA genotypes to respond to MTX treatment.

OPINIONS AND ATTITUDES OF CZECH CITIZENS ON SELECTED ISSUES OF DRUGS IN SOCIETY.

The social sciences within health care and pharmacy provide various points of view on issues often managed by professionals both inside and outside of the health care system. This multidisciplinary perspective often leads to divergent views and sometimes seemingly contradictory viewpoints and solutions. This paper is devoted to the opinions and attitudes of Czech citizens on selected issues of healthcare and pharmacy, the elucidation of which could be a source for understanding the relationships among participants in our pluralist health care system as a whole. This article presents the results of a sociological survey featuring a representative sample in terms of gender, age and region of 1,797 respondents from the Czech population aged 15 and over. The research is focused on the issues of self-medication, choice of pharmacy, out of pocket expenditures on prescription drugs and over-the-counter medicines, experiences with side effects and finally an evaluation of patient comprehension of information leaflets accompanying health care products. According to the results presented here, at the onset of a health problem most of the population tries to treat the condition themselves before seeing a doctor (54.1% always, 30.9% sometimes). Over-the-counter drugs are purchased generally in classic pharmacies without self-service (96.1%). The choice of pharmacy is determined primarily by proximity, with much less importance placed on personal experience or lower price. According to the survey, Czechs spend around 150 CZK (€ 5.9) for over-the-counter medicines and around 143 CZK (€ 5.6) for prescription drugs per month; 77.9% of Czech citizens were shown to understand the information provided on package leaflets. These data help to understand the perception, orientation and behavior of the patient in the healthcare system, with the ultimate goal of leading to higher system effectiveness as well as greater satisfaction for all parties involved.

USE OF MEDICINES AMONG STUDENTS OF HIGH SCHOOLS IN THE CZECH REPUBLIC.

The aim of the study was to examine the prevalence and type of medicines used by high school students in the Czech Republic and to analyze association between use of medicines during last 6 months and self medication with different socio-demographic and lifestyle aspects. A cross-sectional study was conducted in high schools from two regions and three towns in the Czech Republic. The study sample was a student population of nine selected high schools. The study was approved by the local Ethics Committees and school board and was conducted in compliance with the ethical principles of the Declaration of Helsinki. Questionnaires respecting anonymity were distributed to the students during the regular class period. Students answered closed and open questions divided into six sections focussing on their experience with chronic and irregular use of medicines, medicines use during last six months, conditions treated, type and source of used medicines. A modified log-linear Poisson regression model with a robust variance estimator (sandwich) was used for statistical analysis. In total, 979 students, aged 14-21 years (mean age 17 years) participated in the study: 32% were male and 68% female; 19% of students reported regular use of medicines for chronic disease. The use of medicines during the last 6 months was reported by 83% of students; 42% of them reported the use of both prescription and over the counter (OTC) medicines; 22% the use only of OTC, and 31% only prescription medicines. Allergy, asthma, disorders of the thyroid gland, atopic dermatitis, and hypertensive diseases were among the most frequent long-term diseases. The most frequent groups of medicines used for the treatment of long-term diseases were systemic antihistamines, thyroid preparations, and respiratory drugs. Nonsteroidal anti-inflammatory medicines, ibuprofen and paracetamol were the most frequently used medicines during last six months. The study results showed quite extensive use of both prescription and OTC medicines in students of high schools between 14-21 years of age in the Czech Republic. Statistically significant associations were found between use of medicines during last 6 months and type of school, sex and chronic diseases, and between self-medication and sex.

Delay in the diagnosis and treatment of pulmonary tuberculosis in Uzbekistan: a cross-sectional study.

BACKGROUND: Early diagnosis and prompt effective therapy are crucial for the prevention of tuberculosis (TB) transmission, particularly in regions with high levels of multi-drug resistant TB. This study aimed to evaluate the extent of delay in diagnosis and treatment of TB in Uzbekistan and identify associated risk factors. METHODS: A cross-sectional study was performed on hospital patients with newly diagnosed TB. The time between the onset of respiratory symptoms and initiation of anti-TB treatment was assessed and delays were divided into patient, health system and total delays. Univariable and multivariable logistic regression analysis was used to evaluate determinants of diagnostic and treatment delay. RESULTS: Among 538 patients enrolled, the median delay from onset of symptoms until treatment with anti-TB drugs was 50 days. Analysis of the factors affecting health-seeking behaviour and timely treatment showed the presence of the patient factor. Self-medication was the first health-seeking action for 231 (43%) patients and proved to be a significant predictor of delay (p = 0.005), as well as coughing (p = 0.009), loss of weight (p = 0.001), and visiting private and primary healthcare facilities (p = 0.03 and p = 0.02, respectively). CONCLUSION: TB diagnostic and treatment delay was mainly contributed to by patient delay and should be reduced through increasing public awareness of TB symptoms and improving public health-seeking behaviour for timely initiation of anti-TB treatment. Efforts should be made to minimise irrational use of antibiotics and support interventions to restrict over-the-counter availability of antibiotics.

Irrational prescribing of over-the-counter (OTC) medicines in general practice: testing the feasibility of an educational intervention among physicians in five European countries.

BACKGROUND: Irrational prescribing of over-the-counter (OTC) medicines in general practice is common in Southern Europe. Recent findings from a research project funded by the European Commission (FP7), the "OTC SOCIOMED", conducted in seven European countries, indicate that physicians in countries in the Mediterranean Europe region prescribe medicines to a higher degree in comparison to physicians in other participating European countries. In light of these findings, a feasibility study has been designed to explore the acceptance of a pilot educational intervention targeting physicians in general practice in various settings in the Mediterranean Europe region. METHODS: This feasibility study utilized an educational intervention was designed using the Theory of Planned Behaviour (TPB). It took place in geographically-defined primary care areas in Cyprus, France, Greece, Malta, and Turkey. General Practitioners (GPs) were recruited in each country and randomly assigned into two study groups in each of the participating countries. The intervention included a one-day intensive training programme, a poster presentation, and regular visits of trained professionals to the workplaces of participants. Reminder messages and email messages were, also, sent to participants over a 4-week period. A pre- and post-test evaluation study design with quantitative and qualitative data was employed. The primary outcome of this feasibility pilot intervention was to reduce GPs' intention to provide medicines following the educational intervention, and its secondary outcomes included a reduction of prescribed medicines following the intervention, as well as an assessment of its practicality and acceptance by the participating GPs. RESULTS: Median intention scores in the intervention groups were reduced, following the educational intervention, in comparison to the control group. Descriptive analysis of related questions indicated a high overall acceptance and perceived practicality of the intervention programme by GPs, with median scores above 5 on a 7-point Likert scale. CONCLUSIONS: Evidence from this intervention will estimate the parameters required to design a larger study aimed at assessing the effectiveness of such educational interventions. In addition, it could also help inform health policy makers and decision makers regarding the management of behavioural changes in the prescribing patterns of physicians in Mediterranean Europe, particularly in Southern European countries.

The trends in antibiotic use by general dental practitioners in the Czech Republic (2006-2012).

We assessed antibiotic prescribing in practical dentistry in the Czech Republic, as antibiotics are widely prescribed by dental practitioners and warning signals of their overuse can be observed. The individual antibiotic prescriptions were extracted from the database of the General Health Insurance Company and further analysed. The proportion of dentists' prescription within the whole primary health-care sector and the rate of prescriptions of particular antibiotics were both in defined daily doses per 1,000 insurees and day (DID) and in number of prescriptions calculated. The proportion of antibiotic use in dentistry increased from 0.63 DID in 2006 to 0.75 DID. We found a decline in use of narrow-spectrum penicillins by 4.8%, tetracyclines by 3.5% and macrolides by 3.6%, accompanied by increasing rate of prescription of aminopenicillins combined with beta-lactamase inhibitor by 8.9% and lincosamides by 8.5%. The consumption of clindamycin and amoxicillin combined with clavulanate in DID has increased by approximately 60% since 2006 thanks to the exclusive prescribing of two commercial oral products only. Factors contributing to this unfavourable trend are commercial influence or defensive medicine practice.

Prescription of evidence-based medicine drugs by general practitioners to patients after myocardial infarction: outcomes from the Czech Republic.

Ischemic heart disease is the most frequent cause of both serious morbidity and mortality of adult population in developed countries. The main aim of the study was to carry out the analysis of general practitioners (GP) prescription of evidence-based therapy in patients after myocardial infarction (MI). Data were retrospectively collected in 2011, by a single application with the help of software that GPs use in their surgeries. All patients of a particular GP who had MI in their history and who were at the time of data collection treated only by GPs (not by the specialists of internal medicine or cardiology) were always included. Four hundred ninety one patients were included in the study. The average age was 70.7 (+/- 11.6) and 69.2% of the involved patients were men. Seventy nine percent of patients used beta-blockers, 80% antiplatelet drugs, 77% statins and 79% used angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs). Forty four percent of patients used drugs from all four groups. The significant prescription decrease was proved in all four groups in dependence on patients' age (p < 0.05). Although the evidence-based medicine usage in patients after MI in the Czech Republic is comparable to other countries, it is not optimal. More intensive involvement of pharmacists in the care of patients after MI would further improve the situation.

Consumption of osteoanabolic drugs and strontium ranelate in the treatment of osteoporosis in the Czech Republic in 2005-2011.

Anti-osteoporosis drugs with osteoanabolic (teriparatide, intact parathormone) and dual (strontium ranelate) mechanism of action are currently available for the treatment of postmenopausal, glucocorticoid induced or male osteoporosis in the Czech Republic (CZ). These expensive drugs are subjects of special prescribing limitations (2nd line treatments). The objective was to analyze trends in consumption of osteoanabolic and dual drugs in the treatment of osteoporosis since their introduction onto the market in CZ (2005-2011). The prescription-based database of the General Health insurance Company of the Czech Republic that covers approximately 60% of the Czech population was used as the data source. An insured person with a recorded prescription for teriparatide (TRPD), intact parathormone (iPTH) or strontium ranelate (SR) in the period of interest was defined as a patient; 271 (224), 77 (75) and 5930 (5545) patients (women) treated with TRPD, iPTH and SR in 2011, respectively, were identified. The median age of patients on TRPD and SR ranged from 71 to 74 years in 2006-2011. The number of patients treated with TRPD between 2009 and 2011 has been stable, while in iPTH the number increased 2.8 times in the same time period. The number of patients treated with SR has been steadily rising since its introduction in 2005. SR was prescribed most often by physicians specialized in internal medicine (42%) and rheumatology (25%). Male patients accounted for 6% of the SR consumers in 2011. The consumption of dual and osteoanabolic drugs has been rapidly increasing. Consumption rates in men (both absolute and relative) have been increasing but still remain relatively low.

Renal drug dosage adjustments and adverse drug events in patients with chronic kidney disease admitted to the hospital: a cross-sectional study.

BACKGROUND: The study aimed to evaluate the agreement of prescribed drug dosages with renal dosing recommendations and describe adverse drug events (ADEs) contributing to hospital admissions of patients with chronic kidney disease (CKD). METHODS: This cross-sectional study focused on CKD patients admitted to University Hospital Hradec Králové, with an estimated glomerular filtration rate below 60 ml/min. The necessity for renal dosage adjustments was determined using the Summary of Product Characteristics (SmPC). For medications requiring renal dosage adjustment according to SmPC, agreement between the prescribed and recommended renal dosage was assessed. ADEs were adjudicated using the OPERAM drug-related hospital admissions adjudication guide. RESULTS: Of 375 CKD patients, 112 (30%, 95% CI 25-34) were prescribed drug dosages in disagreement with SmPC renal dosage recommendations. Perindopril, metformin, and ramipril were most frequently dosed in disagreement with SmPC. ADE-related hospital admissions occurred in 20% (95% CI 16-24) of CKD patients. CONCLUSION: CKD patients are often prescribed medication dosages in disagreement with SmPC renal dosing recommendations. Besides explicit factors, treatment goals, feasibility of monitoring and alternative treatment must be weighed when assessing drug and dosage appropriateness. Gastrointestinal bleeding was the most frequent ADE that contributed to hospital admissions of CKD patients.

Polypharmacy and malnutrition.

PURPOSE OF REVIEW: Malnutrition and polypharmacy increase with age and polymorbidity and their relationship is based on a number of mechanisms. The occurrence of malnutrition in both in-patients and out-patients and its dependence on polymorbidity and age are well known, but the interrelation of polypharmacy and malnutrition has been far less investigated. The countries with the highest occurrence of polypharmacy in Europe include the Czech Republic and Finland, whereas the lowest prevalence of polypharmacy is found in Norway and the Netherlands. RECENT FINDINGS: The occurrence, consequences and mutual relationship of malnutrition and polypharmacy are described. Up-to-date knowledge regarding the influence of drugs on nutritional status is summarized. SUMMARY: The effect of polypharmacy on nutrition is suggested from the observations that problems with nutrition occur mostly in elderly patients, and that such patients are more frequently subject to polypharmacy. It is known that about 65% of hospitalized patients have a worse nutritional status than their healthy contemporaries. A worsened nutritional status may adversely influence the process of treatment.

The use of molecularly imprinted polymers for the multicomponent determination of endocrine-disrupting compounds in water and sediment.

The method employing molecularly imprinted polymers for the extraction and clean up of endocrine-disrupting compounds (estrogens, bisphenol A, and alkylphenols) from water and sediment is described. The identical extraction/clean-up and LC-MS/MS condition were used for the analysis of both types of samples. The method showed high recoveries ranging from 90 to 99% with excellent precision (intrabatch: 3.6-9.3%; interbatch: 5.6-11.4% for water; intrabatch: 4.3-8.5%; interbatch: 6.1-9.6% for sediment). The LOD was in the range of 0.7-1.9 ng/L and 0.3-0.6 ng/g for water and sediment, respectively. Overall extraction on molecularly imprinted polymers substantially enhanced sample clean-up. The difference in efficiency of clean-up was particularly pronounced when a large sample volume/weight was extracted and analyzed. Finally, the method was successfully applied for the analysis of 20 water and sediment samples.

Online molecularly imprinted solid-phase extraction coupled to liquid chromatography-tandem mass spectrometry for the determination of hormones in water and sediment samples.

The molecularly imprinted SPE directly coupled to RP LC-MS/MS method has been developed and successfully validated for the determination of six hormones in water and sediment samples. The method is based on the use the home-made column filled with a molecularly imprinted sorbent (imprinted against estrogens) that was used under nonaqueous conditions. Thus, its high selectivity could be utilized resulting in low matrix components' coextraction. The method showed excellent recovery (92-105%) and satisfactory sensitivity (LOQs water: 1.9-4.0 ng/L; LOQs sediment: 0.2-0.5 ng/g). The intra- and interprecision for water and sediment was in the range of 4.0-6.0% and 4.4-7.6%, respectively. Finally, 20 water and sediment samples collected from the Svratka river were analyzed. Only estrone was quantified in eight water samples (4.4-7.1 ng/L); no analytes were found in sediment samples.

Analysis of pharmacists' opinions, attitudes and experiences with generic drugs and generic substitution in the Czech Republic.

Generic substitution (GS) is an integral part of drug policy in many countries. Similarly to other countries its introduction in the Czech Republic gave rise to a vibrant discussion. The aim of the study was to map and analyze pharmacists' opinions of, attitudes towards and experiences with generic drugs and GS after the first year from its legislative embodiment in the Czech Republic. All 7,665 members of the Czech Chamber of Pharmacists were addressed to participate in a questionnaire survey between November 2008 and March 2009. The questionnaire consisted of 28 questions concerning the issue of generic drugs and GS and was divided into five sections. All collected data were analyzed using descriptive statistics and correlations were tested by selected parametric and non-parametric tests. A total of 615 completed questionnaire forms were returned (a questionnaire return rate of 8.0%). The demographic characteristics of the respondents were as follows: 470 (76.4%) females, mean age of 37.5 years (SD = 10.4) and 429 (69.6%) pharmacists with a practice specialization. Altogether 345 (56.1%) respondents became aware of the issue of brand name and generic drugs during their undergraduate studies. 378 (61.5%) respondents considered generic drugs as bioequivalent and 455 (74.0%) respondents as therapeutically equivalent to the respective brand name drugs. 99 (16.1%) pharmacists believed that generic products are of lower quality than branded drugs and 69 (11.2%) respondents expected generics to cause more adverse drug reactions. GS was perceived as a positive tool by 476 (77.4%) respondents. Only 71 (11.5%) respondents showed acquaintance with all the legal rules for GS. Legislation awareness and attitude towards GS was correlated with age (p < 0.001). The use of GS in the routine practice depends on the pharmacists' familiarity with the relevant legislation and attitude towards generic drugs and GS. Approaching patients on an individual basis and pharmacists' awareness can minimize adverse drug events caused by generic drugs and at the same time enhance the professional status of pharmacists.

Analysis of the consumption of sedative and hypnotic drugs in Yemen and the Czech Republic.

The aim of this project is to analyze the consumption and reasons for the use of sedative and hypnotic drugs (ATC: N05B and N05C) (SHD) in Yemen (YEM) and to compare this with the consumption of SHD in the Czech Republic (CZ) and in YEM, in the years 2000-2005. In 2005 the consumption of SHD in YEM and in CZ was 0.20 and 6.9 USD/1000 citizens/day, respectively. The consumption of SHD in YEM and in CZ increased after 2000 by 637% and 85%, respectively. A pilot questionnaire tested the factors influencing the consumption of SHD in YEM. 72% of respondents were male; 48% had obtained SHD the first time without a prescription; 90% had engaged in the long term use of SHD; 43% did not know the risks of SHD and the majority of users are most likely young people. The increasing consumption of SHD may be caused by the frequent prescribing of drugs for off-label use, obtaining SHD in the pharmacy without prescription and the common chewing of qat and the lack of warnings about long term risks.