Drug Items Research Articles

Pharmacoeconomic analysis of drug expenditure in government medical college and hospital, Vijayawada, India

Background: To conduct economic analysis in tertiary care hospital with a view to identify the categories of drugs needing stringent management control.Methods: The annual consumption and expenditure data is obtained from the drug store of government general hospital, Vijayawada, for the period of April 2015 to March 2016. ABC-VED analysis of the drugs are done based on cost and criticality criteria respectively. ABC-VED matrix analysis was done to classify drugs into category I, II, III.Results: The total annual drug expenditure incurred on 299 drug items for the year 2015-2016 was found to be Rs:4,47,04,446. On ABC analysis, 4%, 9.36%, 86.64% of drugs were found to be Always, Better, and Control category items respectively, amounting to 68.92%, 20.05%, 11.03% of annual drug expenditure. VED analysis showed that 32.10%, 45.5%, 22.4% of drug items were Vital, Essential, and Desirable category items respectively, amounting to 35.3%, 37.1%, 27.6% of annual drug expenditure respectively. By ABC-VED matrix analysis, 34.11%, 46.49%, 19.4% of drug items were found to be category I (high stringent), II (medium stringent), III (low stringent) respectively, amounting to 80.76%, 17.46%, 1.77% of annual drug expenditure respectively.Conclusions: The study identified 34.11% of drug items belonging to category I which require high priority monitoring. Inventory management tools must be routinely used for the better control and judicious use of the resources.

Drug Management Evaluation Focusing on Procurement at Muntilan District Hospital Magelang in Year 2015–2016

Planning and procurement which are parts of management drug supply give the biggest effect on drug inventory and hospital’s cost. This study aimed to describe planning and procurement systems in Pharmacy Department of Muntilan Regional Public Hospital in year 2015–2016. Study was conducted by comparing the real drug management supply indicators with standard indicators. This study was conducted on December 2016 untill February 2017. Data was collected using retrospective approach for secondary data including data of finance, drug procurement and use; as well as primary data collected by interview with hospital director, and heads of pharmacy and finance department. Data was analyzed using descriptive technique. The result showed that drug management had not been fully in accordance with the standards. It was indicated from 7 measured indicators, one of them had been in accordance with the standard which was percentage of available fund compared with cost planned. The other 6 indicators had not been in accordance with the standard: percentage of drug procurement with fund allocation, percentage of drug item planned compared with the using, percentage total quantities of a drug item with the using, the procurement frequency of each drug item, frequency uncompleted of orderlist/contract, frequency of delayed rate in payment by hospital, and indicators that can’t be measured are proportion of the quantities of products actually recieved out of total quantities planned, and percentage of quantities used out of total quantities available for consumption after deduction of buffer stock.

Comparing cryptomarkets for drugs. A characterisation of sellers and buyers over time

IntroductionCryptomarkets operating on the darknet are a recent phenomenon that has gained importance only over the last couple of years (Barratt, 2012). However, they now constitute an evolving part of illicit drug markets. Although selling and buying a variety of psychoactive substances on the Internet has a long history, new technological developments enable systematic drug trading on the net.These technological innovations on the Internet allow users to proceed with (illicit) drug transactions with almost completely anonymous identities and locations. In this paper, we provide a systematic measurement analysis of structures and trends on the most popular anonymous drug marketplace, and discuss the role of cryptomarkets in drug distribution. MethodsData collection and analysis include a long-term measurement of the cryptomarket ‘AlphaBay', the most popular platform during the survey period. By developing and applying a web-scraping tool, market data was extracted from the marketplace on a daily basis during a period of twelve months between September 2015 and August 2016. The data was analysed by using business-intelligence software, which allows the linking of various data sets. We found 2188 unique vendors offering 11,925 drug items. The findings of our long-term monitoring and data analysis are compared over time and across marketplaces, offering a detailed understanding of the development of revenues generated, characterisation of countries of origin and destination, and distribution of vendors and customers over time. ResultsWe provide a nuanced and highly detailed longitudinal analysis of drug trading on the darknet marketplace ‘AlphaBay', which was the largest cryptomarket in operation. 1) Total sales volumes for the ‘drugs' section was estimated at approximately USD 94 million for the period from September 2015 to August 2016. 2) In addition, about 64% of all sales are made with cocaine-, cannabis-, heroin-, and ecstasy-related products. 3) Average selling prices increase over time for categories including cannabis and hashish, ecstasy, opioids, psychedelics and stimulants. 4) The five most frequent countries of origin as indicated by vendors are the United States, United Kingdom, Australia, the Netherlands and Germany. Moreover, it was demonstrated that drug distribution on cryptomarkets is conducted at a regional rather than global level. 6) Furthermore, 4.88% of vendors made over USD 200,000 and were responsible for 52.9% of total revenues generated over the period analysed. In contrast, 57.51% of vendors managed to sell drug items worth less than USD 10,000 within a period of twelve months. The findings suggest that ‘AlphaBay' was a cryptomarket mainly from and for Western industrialised countries. In contrast, countries of the global South are neither among the main countries of origin nor destination countries.

PD31 Financial Impact Of Target Molecular Therapies In A Brazilian Hospital

Introduction:The therapy using molecular-targeted (MTT) and monoclonal antibodies (MA) are examples of new therapeutic technologies in search of greater clinical effectiveness and reduction of adverse effects in the fight against frequent diseases. Generally, new technologies have a high cost impact on the health system. The objective of this study was to evaluate the financial impact generated by the use of MTT and MA therapies in the teaching Hospital de Clínicas, Porto Alegre, Brazil.Methods:The first 60 higher monetary spending drug items of the last 12 months were analyzed. From them, drugs which fit in the categories under study, and have been regularly used, were identified. The monthly expenditures with each item were tabulated and compared with the total expenditures on drugs, in order to calculate the budgetary impact. The major groups of diseases treated with each agent were analyzed.Results:Two MTT agents (gefitinib and infliximab) and three MAs (rituximab, basiliximab and abciximab) were identified. The highest expenditure items, respectively, per year, were the oncological medicines rituximab (USD127,890) and gefitinib (USD96,923), followed by the immunosuppressive basiliximab (USD88,998) and the immunomodulatory infliximab (USD68,642), and the platelet aggregation inhibitor abciximab (USD47,886). These values corresponding to, respectively, 1.1 percent, 0.8 percent, 0.8 percent, 0.6 percent and 0.4 percent of total drug expenditure per year (USD11,866,124). Trastuzumab, bortezomib and imatinib were often used, but directly supplied by the public system, in a way that didn't impact the hospital budgetary management.Conclusions:MTT and MA have an important impact on health budgets, and are mainly used to treat some types of cancer, cardiovascular disease and autoimmune disorders. These aspects should be considered in the management of drugs in hospitals of high complexity.

Evaluasi Kesesuaian Dosis pada Pasien Pediatri Bronkitis Akut di Rumah Sakit Tentara Kartika Husada Kubu Raya

Selection and usage of rational drugs determine the success of expected therapeutic effect, especially for pediatrics. Acute bronchitis in pediatrics is one of the highest incidents of Acute Respiratory Infection (ARI) in Army Hospital Kartika Husada Kubu Raya. This study aimed to evaluate rationality of drug doses conformity in outpatient pediatric acute bronchitis in Army Hospital Kartika Husada Kubu Raya on 2015. This research was a descriptive observational research with cross-sectional design. The sample was taken with purpossive sampling amounted to 36 prescriptions. Then the evaluation of drug doses conformity was counted based the literature. The results showed that drugs which were used for acute bronchitis were mucolitics and expectorants, antibiotics, bronchodilators, multivitamins, decongestans, analgesics, and antihistamins. The result of drug dosage conformity evaluation showed that the under-dose drug item (R/) was 51%, over-dose was 15% and appropriate dose was 34%.

Self-medication with antibiotics in Serbian households: a case for action?

Background Irregular antibiotic use, including self-medication contributes to the development of antibiotic resistance. One method of accessing antibiotic use in the community is through obtaining an in house inventory of drugs. Objective The aim of this study was to investigate the extent of storage and self-medication with antibiotics agents in households in Novi Sad, Serbia. Setting Households in Novi Sad. Method The study was performed during a 4-month period (October 2015-January 2016) using a sample of 112 households in Novi Sad, Serbia. Two trained interviewers performed the survey by visiting each household. The study consisted of making an inventory of all drugs in household and a semi-structured interview about drug use practices and perceptions. Main outcome measure Number of antibiotics obtained without prescription. Results Out of 112 surveyed households, antibiotics were encountered in 55 (49.1%). Antibiotics constituted 11.98% (92/768) of total number of drug items in households. Out of all antibiotics in households, 41 (44.57%) were not in current use, and presented left-overs from previous treatment. Antibiotics were usually acquired with prescription (67, 67.7%), while about a quarter of packages were used for self-medication-purchased at pharmacy without prescription (19, 20.65%) or obtained through friends or family member (6, 6.52%).The most commonly used antibiotics for self-medication was amoxicillin (reported indications included common cold, cough, pharyngitis and tooth-ache). Conclusion Antibiotics were present in large share of households in Novi Sad. Self-medication with antibiotics and sale of antibiotics without prescription represent an important problemin Serbia.

Essential drug stock alert tracker in provincial department of Health Services Western Province

Introduction The health indices in Sri Lanka are well above the regional health indices, which can be partly attributed to the free health care system. However, lack of pharmacy supplies in government health institutions, especially in divisional hospitals, is a major complaint from the general public. Health care institutions under the purview of Provincial Director of Health Services (PDHS) receive pharmacy items from the Regional Medical Supplies Division (RMSD). Some of the reasons for shortage of pharmacy items are poor communication between RMSD and health institutions, mal-distribution of items at RMSD and actual drug shortage. Currently there is no manual or electronic mechanism to monitor the institution’s essential drugs at any level, resulting in difficulty to replenish stocks in a timely manner. Objective The objective of this system is to alert the health care institutional heads and regional/provincial administrators about essential drug status and to effectively mobilize the available drugs. Methods A Web based system was designed with a simple data entry format and color code system. A dashboard facilitates the visualization of the available stock with green (satisfactory), yellow (reorder), red (zero stock). User levels in the system include institution, RMSD, Regional and Provincial levels. Currently 26 essential drug items are monitored by the system. Results Before implementing the system, there were 38 occasions (11.73%) of zero stock level for any of the 26 essential drugs in Divisional hospitals. In 66(20.37%) occasions the drugs were at low stock level. This has improved to 1.54% and 8.02% respectively as at April 2016. Conclusion Both Knowledge and Practices for a preparedness of a chemical hazard were not adequate. Some key factors were significantly associated with service duration and teaching subject at school of study subjects. Policy guidelines to assess the disaster drills, training programmes ensuring attendance of all school population are recommended. Coordinated assistance from Disaster Management Centre and health sector should be arranged.

Managing Drug Inventory by ABC Critical Index Method in Primary Healthcare Center in Bandung, Indonesia

A Primary Healthcare Center (PHC) is one of the primary health care facilities that are very important in Indonesia for the implementation of NHI. The funding for PHC operations were obtained from the central government, local government, and the capitation funds of NHI. Capitation funds were received by the first-level healthcare facilities from the board and were fully utilized for the payment of health care services and health operating costs. PHC has the spearhead of service and health development in Indonesia, because it is a health facility that is most widely used by the society. The purpose of this study is to determine the management of drugs’ inventory in a PHC in Bandung. The cross sectional study was conducted using observational analysis along with the ABC Critical Index method. The inventory data was obtained from drugs usage and the critical score was obtained from questionnaire distributed to prescribers within the PHC. ABC Critical Index analysis results showed that there were 19 (9.09%) drug items in group A, 148 (70.81%) drugs items in group B, and the remaining 42 (20.10%) drug items in group C. The cost of drug procurement in this PHC district is 133,464 USD with the Acute Respiratory Infection (ARI) as the most common disease. The management of drugs with ABC Critical Index method in a PHC in Bandung is determined.

Magistral drugs in hospitalized newborns and children

ObjectiveStudy the use of magistral oral solutions and suspensions in infants and children at a university hospital. MethodsThis is a descriptive study based on the analysis of the assessed hospital's magistral drug request forms regarding the patients in the neonatal ICU, Obstetrics, Pediatrics and Pediatric Emergency from January 2012 to December 2013. The frequency of drug requests and dispensation was evaluated and the consumption of each active ingredient of the preparations was expressed as number of “infant defined daily dose” (iDDD) and of iDDD/100 bed-days. ResultsA total of 657 forms were analyzed – a monthly average of 27 pediatric preparations. The neonatal ICU accounted for 69.6% of these requests. Twenty-one drug items were used, of which the most common were folinic acid (88 requests), sulfadiazine (85) and captopril (73). The consumption of the active principle in these preparations varied in number of iDDD, from 7.5 (hydralazine) to 16,520.0 (folic acid), and in number of iDDD/100 bed-days in the neonatal ICU, from 0.1 (zinc sulfate) to 146.1 (folic acid). ConclusionsThe constant consumption of magistral oral solutions and suspensions by newborns and children of the assessed hospital indicates the need for such preparations as a pediatric therapeutic alternative in this hospital.

Medicamentos magistrais em recém‐nascidos e crianças hospitalizados

ObjectiveStudy the use of magistral oral solutions and suspensions in infants and children at a university hospital. MethodsThis is a descriptive study based on the analysis of the assessed hospital's magistral drug request forms regarding the patients in the neonatal ICU, Obstetrics, Pediatrics and Pediatric Emergency from January 2012 to December 2013. The frequency of drug requests and dispensation was evaluated and the consumption of each active ingredient of the preparations was expressed as number of “infant defined daily dose” (iDDD) and of iDDD/100 bed‐days. ResultsA total of 657 forms were analyzed – a monthly average of 27 pediatric preparations. The neonatal ICU accounted for 69.6% of these requests. Twenty‐one drug items were used, of which the most common were folinic acid (88 requests), sulfadiazine (85) and captopril (73). The consumption of the active principle in these preparations varied in number of iDDD, from 7.5 (hydralazine) to 16,520.0 (folic acid), and in number of iDDD/100 bed‐days in the neonatal ICU, from 0.1 (zinc sulfate) to 146.1 (folic acid). ConclusionsThe constant consumption of magistral oral solutions and suspensions by newborns and children of the assessed hospital indicates the need for such preparations as a pediatric therapeutic alternative in this hospital.

Why Do Drug Prescribing Rates Differ Across Irish Regions?

In Ireland 68.3 m drug items were prescribed in 2010, a national average prescribing rate (APR) of 14.9 items per person. Regional APRs ranged from 13.2 items in the East to 17.1 items in the South-East region. We construct a model of regional prescribing rates in Ireland that embeds the effects of the national prescribing rates under each of Ireland’s three main community drug schemes, the regional coverage rates of those schemes and each region’s health status. Drawing on the CPS Composite Health Index to measure regional health status and the Primary Care Reimbursement Service database for all other variable, we estimate the model by Ordinary Least Squares (OLS). We find that variations in regional prescribing rates were mainly due to the different regional coverage rates of Ireland’s community drug schemes, especially its GMS (General Medical Services) community drug scheme and, to a lesser extent, to differences in each region’s health status. We simulate the estimated model and find that a percentage point reduction in each region’s GMS coverage rate would reduce the number of items prescribed nationally twice as much as a percentage point gain in each region’s health status. We find that regional prescribing rates respond most to changes in national prescribing rates in low-income regions that have high GMS coverage rates and poor health status. At the height of Ireland’s public debt crisis in 2010, government policy pressured GMS national prescribing rates down by around 2% in an effort to contain public drug costs. That reduced regional prescribing rates most in low-income regions that had high GMS coverage rates and poor health status.

Evaluation of Hand Written and Computerized Out-Patient Prescriptions in Urban Part of Central Gujarat.

Prescription order is an important therapeutic transaction between physician and patient. A good quality prescription is an extremely important factor for minimizing errors in dispensing medication and it should be adherent to guidelines for prescription writing for benefit of the patient. To evaluate frequency and type of prescription errors in outpatient prescriptions and find whether prescription writing abides with WHO standards of prescription writing. A cross-sectional observational study was conducted at Anand city. Allopathic private practitioners practising at Anand city of different specialities were included in study. Collection of prescriptions was started a month after the consent to minimize bias in prescription writing. The prescriptions were collected from local pharmacy stores of Anand city over a period of six months. Prescriptions were analysed for errors in standard information, according to WHO guide to good prescribing. Descriptive analysis was performed to estimate frequency of errors, data were expressed as numbers and percentage. Total 749 (549 handwritten and 200 computerised) prescriptions were collected. Abundant omission errors were identified in handwritten prescriptions e.g., OPD number was mentioned in 6.19%, patient's age was mentioned in 25.50%, gender in 17.30%, address in 9.29% and weight of patient mentioned in 11.29%, while in drug items only 2.97% drugs were prescribed by generic name. Route and Dosage form was mentioned in 77.35%-78.15%, dose mentioned in 47.25%, unit in 13.91%, regimens were mentioned in 72.93% while signa (direction for drug use) in 62.35%. Total 4384 errors out of 549 handwritten prescriptions and 501 errors out of 200 computerized prescriptions were found in clinicians and patient details. While in drug item details, total number of errors identified were 5015 and 621 in handwritten and computerized prescriptions respectively. As compared to handwritten prescriptions, computerized prescriptions appeared to be associated with relatively lower rates of error. Since out-patient prescription errors are abundant and often occur in handwritten prescriptions, prescribers need to adapt themselves to computerized prescription order entry in their daily practice.

ABC-VED matrix analysis of Government Medical College, Aurangabad drug store

Background: Substantial improvement can be brought about in the hospital inventory and drug expenditure by inventory control techniques. These include ABC (always, better and control), VED (vital, essential and desirable) and ABC-VED Matrix analysis. The objective of the study was to categorize the drugs based on cost and criticality aspects and identify those which require stringent managerial control. Methods: The ABC analysis according to expenditure on drugs and VED analysis according to the criticality of the drugs was done for drug store of GMCH, Aurangabad for the period of April 2014 to March 2015. ABC-VED matrix analysis was done to classify drugs into Category 1, 2 and 3. Category 1 included drugs requiring top managerial control, whereas category 2 and 3 included drugs requiring middle and lower managerial control respectively. Results: The total number of the drug items used by the medical store was 119. The total drug expenditure was Rs. 4,08,53,968. By ABC analysis, it was found that 16.8%, 21.8% and 61.4% items belonged to A, B and C category respectively, accounting for 70%, 20.1% and 9.9% of expenditure. VED analysis showed that 35.3%, 50.4% and 14.3% were V, E, and D category items respectively, accounting for 34.3%, 49.5% and 16.2% of expenditure. By ABC-VED matrix analysis, 47.9%, 43.7% and 8.4% were found to be category I, II and III items respectively, accounting for 82.3%, 16.5% and 1.2% of drug expenditure. Conclusions: The study depicted the items belonging to category I which requires top managerial control, also the items belonging to categories II and III which require control by middle and lower managerial level respectively.

Tablet splitting of narrow therapeutic index drugs: a nationwide survey in Taiwan

Tablet splitting or pill splitting frequently occurs in daily medical practice. For drugs with special pharmacokinetic characters, such as drugs with narrow therapeutic index (NTI), unequal split tablets might lead to erroneous dose titration and it even cause toxicity. The aim of this study was to investigate the frequency of prescribing split NTI drugs at ambulatory setting in Taiwan. A population-based retrospective study was conducted using the National Health Insurance Research Database in Taiwan. All ambulatory visits were analyzed from the longitudinal cohort datasets of the National Health Insurance Research Database. The details of ambulatory prescriptions containing NTI drugs were extracted by using the claims datasets of one million beneficiaries from National Healthcare Insurance Research Database in 2010 in Taiwan. The analyses were stratified by dosage form, patient age and the number of prescribed tablets in a single dose for each NTI drugs. Main outcome measures Number and distinct dosage forms of available NTI drug items in Taiwan, number of prescriptions involved split NTI drugs, and number of patients received split NTI drugs. A total of 148,548 patients had received 512,398 prescriptions of NTI drugs and 41.8 % (n = 62,121) of patients had received 36.3 % (n = 185,936) of NTI drug prescriptions in form of split tablets. The percentage of splitting was highest in digoxin prescriptions (81.0 %), followed by warfarin (72.0 %). In the elderly patients, split tablets were very prevalent with digoxin (82.4 %) and warfarin (84.5 %). NTI drugs were frequently prescribed to be taken in split forms in Taiwan. Interventions may be needed to provide effective and convenient NTI drug use. Further studies are needed to evaluate the clinical outcome of inappropriate split NTI drugs.

Physicians Failed to Write Flawless Prescriptions When Computerized Physician Order Entry System Crashed

PurposeClinical care has become increasingly dependent on computerized physician order entry (CPOE) systems. No study has reported the adverse effect of CPOE on physicians’ ability to handwrite prescriptions. This study took advantage of an extensive crash of the CPOE system at a large hospital to assess the completeness, legibility, and accuracy of physicians’ handwritten prescriptions. MethodsThe CPOE system had operated at the outpatient department of an academic medical center in Taiwan since 1993. During an unintentional shutdown that lasted 3.5 hours in 2010, physicians were forced to write prescriptions manually. These handwritten prescriptions, together with clinical medical records, were later audited by clinical pharmacists with respect to 16 fields of the patient’s, prescriber’s, and drug data. FindingsA total of 1418 prescriptions with 3805 drug items were handwritten by 114 to 1369 patients. Not a single prescription had all necessary fields filled in. Although the field of age was most frequently omitted (1282 [90.4%] of 1418 prescriptions) among the patient’s data, the field of dosage form was most frequently omitted (3480 [91.5%] of 3805 items) among the drug data. In contrast, the scale of illegibility was rather small. The highest percentage reached only 1.5% (n = 57) in the field of drug frequency. Inaccuracies of strength, dose, and drug name were observed in 745 (19.6%), 517 (13.6%), and 435 (11.4%) prescribed drug items, respectively. ImplicationsThe unintentional shutdown of a long-running CPOE system revealed that physicians fail to handwrite flawless prescriptions in the digital era. The contingency plans for computer disasters at health care facilities might include preparation of stand-alone e-prescribing software so that the service delay could be kept to the minimum. However, guidance on prescribing should remain an essential part of medical education.

ABC and VED Analysis of the Pharmacy Store of a Tertiary Care, Academic Institute of the Northern India to Identify the Categories of Drugs Needing Strict Management Control

Aim: To conduct ABC, VED and ABC-VED matrix analysis of the pharmacy store of the tertiary care, teaching, research and referral institute of the Northern India to identify the categories of drugs needing strict management control Method: The ABC and VED (vital, essential, desirable) analysis of the pharmacy/drug store of Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, was conducted to identify the categories of drugs needing strict management control. The annual consumption and expenditure incurred on each drug item of pharmacy for the year 2008-09 and 2009-10 were studied and inventory control techniques, i.e. ABC, VED and ABC-VED matrix analysis, were applied. Results: The drug formulary consisted of 416 items (year 2008-09) and 379 drug items (year 2009-10). The total annual drug expenditure (ADE) on items issued in 2008-09 & 2009-10 was Rs 6.04 crores to Rs 4.84 crores respectively. ABC analysis of pharmacy store for the year 2008-09 revealed 11.23%, 24.60% and 75.4% items as A, B and C category items, respectively, accounting for 70.19%, 19.83% and 9.98% of ADE of the pharmacy. VED analysis showed 12.30%, 61.5% and 26.2% items as V, E, and D category items, respectively, accounting for 19.56%, 71.12% and 9.33% of ADE of the pharmacy. However ABC analysis of pharmacy store for the year 2009-10 revealed 11.08%, 22.16% and 66.75% items as A, B and C category items, respectively, accounting for 70.04%, 19.93% and 10.02% of ADE of the pharmacy. VED analysis showed 12.40%, 60.16% and 27.44% items as V, E, and D category items, respectively, accounting for 25.05%, 66.91% and 8.04% of ADE of the pharmacy. Conclusion: The ABC and VED techniques should be adopted for optimal and rational use of resources and elimination of out-of-stock situations in the hospital pharmacy. Key words: ABC analysis, ABC-VED matrix, inventory management, pharmacy, VED analysis.

Home pharmacies in Serbia: an insight into self-medication practice.

Worldwide data indicate that self-medication is frequently used inappropriately. Although self-medication is encouraged in most of the countries by introducing over-the-counter drugs, it bears the risk of misuse of drugs issued on prescription due to low observance of legislation of medicines requiring prescription by some pharmacies. The objective of this study was to explore the self-medication practice, with an emphasis on self-medication with prescription-only medications. Households in Novi Sad city, Serbia. The study was conducted over 8 month period (December 2011-July 2012) and involved a random sample of households. The questionnaire-based study and personal insight into household drug supplies was performed by a trained interviewer. Main outcome measure Number of drugs obtained without prescription or without consulting a physician in surveyed households. The total number of drug items present in the 383 households was 4,384 with a median of 11 drugs per household. More than a half of drugs in households were prescription-only medication (58.5 %). Approximately one third of prescription-only medications were obtained without prescription. The most common drugs obtained without prescription were anti-inflammatory and antirheumatic products and antibacterials for systemic use. Ibuprofen and diclofenac were the most common self-medicated drugs. Number of prescription-only medications bought with ought prescription was significantly higher in households with children under 12 years of age compared to other types of households. Our survey indicated that self-medication with prescription drugs appeared to be a rather common practice, which is far away from the concept of "responsible self-medication", especially regarding antibiotics.

Evaluating drug trafficking on the Tor Network: Silk Road 2, the sequel

BackgroundHousing an illicit, online drug retail market generating sales in the millions of USD, the Silk Road was a profitable marketplace with a growing and loyal consumer base. Following its FBI-forced shut down in October 2013, the Silk Road enjoyed newfound fame that contributed to an increase in new users downloading and accessing the Tor Network; however, with this particular marketplace out of order, Silk Road 2 was launched to fill the void. The goals of this study were to (1) compare the metrics of Silk Road 2 to the original site, and to (2) determine if there were any indications of the presence of more sophisticated drug trafficking operations. MethodsData were collected from Silk Road 2 during the months of August and September 2014 using webcrawling software. ResultsSilk Road 2 was a much smaller marketplace than the original Silk Road. Of the 1834 unique items for sale, 348 were drug items sold by 145 distinct vendors shipping from 19 countries. Of the drug items advertised, most were stimulants and hallucinogens. The United States is both the number one country of origin for drug sales on Silk Road 2 and the number one destination country. Interestingly, 73% of all vendor accounts on Silk Road 2 advertised drug items, even though drugs only constituted 19% of all items advertised. ConclusionThis study was the first to research Silk Road 2, the replacement illicit marketplace to the original virtual Silk Road. This study was also the first to examine indications of the presence of more coordinated drug trafficking efforts in an online setting. The findings indicated that while Silk Road 2 was not primarily a drug market, there were indications that some vendor accounts may have connections reaching beyond a base retail market.

Controlled drugs: Regulations and prescribing

The total number of controlled drug (CD) items prescribed in NHS primary care in 2013 was 47 044 814. As GPs we have a duty to keep up-to-date on all aspects of CD management, including safe storage, record keeping, supply, administration and disposal. As a result of Harold Shipman’s actions, a GP and serial killer who used CDs to kill his patients, governance arrangements for the use and management of CDs have been strengthened. Making errors in this area affects patient safety and could even lead to criminal proceedings for the individual involved. This article aims to outline a safe approach to situations where CDs affect clinical practice.

Implementing a bar-code assisted medication administration system: Effects on the dispensing process and user perceptions

PurposeWe assessed the effects of a bar-code assisted medication administration system used without the support of computerised prescribing (stand-alone BCMA), on the dispensing process and its users. MethodsThe stand-alone BCMA system was implemented in one ward of a teaching hospital. The number of dispensing steps, dispensing time and potential dispensing errors (PDEs) were directly observed one month before and eight months after the intervention. Attitudes of pharmacy and nursing staff were assessed using a questionnaire (Likert scale) and interviews. ResultsAmong 1291 and 471 drug items observed before and after the introduction of the technology respectively, the number of dispensing steps increased from five to eight and time (standard deviation) to dispense one drug item by one staff personnel increased from 0.8 (0.09) to 1.5 (0.12)min. Among 2828 and 471 drug items observed before and after the intervention respectively, the number of PDEs increased significantly (P<0.001). ‘Procedural errors’ and ‘missing drug items’ were the frequently observed PDEs in the after study. ‘Perceived usefulness’ and ‘job relevance’ of the technology decreased significantly (P=0.003 and P=0.004 respectively) among users who participated in the before (N=16) and after (N=16) questionnaires surveys. Among the interviewees, pharmacy staff felt that the system offered less benefit to the dispensing process (9/16). Nursing staff perceived the system as useful in improving the accuracy of drug administration (7/10). ConclusionImplementing a stand-alone BCMA system may slow down and complicate the dispensing process. Nursing staff believe the stand-alone BCMA system could improve the drug administration process but pharmacy staff believes the technology would be more helpful if supported by computerised prescribing. However, periodical assessments are needed to identify weaknesses in the process after implementation, and all users should be educated on the benefits of using this technology.