Reasons that lead people to buy prescription medicines on the internet: a systematic review.

Aim: This systematic review explores the factors that could influence consumer's decision of purchasing prescription medicines using the Internet. Methods: Relevant databases were searched to retrieve studies published from 2012 to 2021. The studies selected for inclusion were those focused on the consumer's perspective and the purchase of prescription medicines. A narrative synthesis was employed. The Capability Opportunity Motivation-Behaviour (COM-B) and the Theoretical Domains Framework (TDF) were employed as conceptual lenses that guided the analysis. Results: Seventeen studies were included. These studies have adopted various methodologies: qualitative method (n = 4), quantitative method (n = 12), and mixed methods (n = 1). The studies were based in Europe (n = 8), North America (n = 3), Middle East (n = 4), and 2 studies were conducted in several countries (multinational). The analysis of these studies revealed 7 themes that represent the reasons that lead people to buy prescription medicines via the Internet. These themes were the consumers' beliefs about the outcomes of the purchase (perceived benefits and risks of the purchase), consumer's emotions that could influence the purchasing decision, the factors that increase or decrease consumer's level of behavioural control over the purchase (facilitators and barriers of the purchase), consumers knowledge about the purchase, the trusting beliefs that lead consumers to trust the online sellers of medicines, the social influencing factors, and the external environmental factors that could encourage the purchase. Discussion: This study provides a comprehensive review of the breadth of reasons that drive people to buy prescription medicines via the Internet. Identifying those reasons could provide the basis for regulators to design evidence-based awareness campaigns to minimise the purchase of prescription medicines via the Internet. Furthermore, future research directions have been provided in this review to build upon the existing knowledge and address the research gaps in this area.

A systematic review of quantitative studies exploring staff views on antipsychotic use in residents with dementia in care homes.

BACKGROUND: Despite significant warnings of adverse effects, antipsychotics continue to be prescribed for managing the behavioural and psychological symptoms of dementia (BPSD) in care homes. Information provided by staff working within care homes is a factor that can influence prescribing decisions in residents with BPSD. AIM: The review aimed to capture care home staff views towards antipsychotics for residents with BPSD and separately analyse tools utilized in the studies, mapping them onto the theory of planned behaviour (TPB). METHOD: A comprehensive literature search published in ten databases was conducted between May and July 2020 and updated in July 2021. Studies published in full with no date restriction were included and quality assessed using CROSS checklist. A thematic framework approach was applied to extract data and study tools which were then mapped onto the TPB. RESULTS: Fourteen studies (2059 participants) were included. Findings identified four overarching themes: attitudes toward antipsychotics (e.g. antipsychotics as an appropriate strategy and effectiveness); barriers to deprescribing (e.g. lower staff education, lack of resources and time, poor medication reviews); measures implemented (e.g. nonpharmacological interventions, medication reviews); and perceived needs of staff (e.g. need for training, financial or clinical support). Identified tools addressed seven but not all components of TPB namely, behavioural, normative and control beliefs, attitude, perceived behavioural control, intention and behaviour. CONCLUSION: The positive attitudes toward antipsychotics, the identified barriers to deprescribing and the existing tools not addressing all components of the TPB provide the impetus for further research.

The impact of epidural analgesia for acute pancreatitis on maternal and fetal outcome: a cohort study.

It is anticipated that between 1 in 10, 000 and 1 in 30, 000 pregnancies will be affected by acute pancreatitis (AP). The authors wanted to evaluate the impact of epidural analgesia on maternal and fetal outcomes and its effectiveness in the pain treatment of obstetric patients with AP. Methodology: The period for this cohort research was from January 2022 to September 2022. Fifty pregnant women with AP symptoms were enrolled in the study. Conservative medical management was done using intravenous (i.v.) analgesics, including fentanyl and tramadol. Fentanyl was infused i.v. at a rate of 1 µg/kg every hour, while tramadol was bolused i.v. at 100 mg/kg every 8 h. Boluses of 10-15 ml of 0.1% ropivacaine were injected into the L1-L2 interspace at 2-3-h intervals to provide high lumbar epidural analgesia. Results: In this study, 10 patients were given an i.v. infusion of fentanyl, and 20 patients were given tramadol boluses. Epidural analgesia showed the most promising results decreasing the visual analog scale score from 9 to 2 in half of the patients. Most fetal complications were noticed in the tramadol group, including prematurity, respiratory distress, and babies requiring noninvasive ventilation. Conclusion: Patients with AP during pregnancy may benefit from a new technique for simultaneous analgesia during labor and cesarean section administered via a single catheter. When AP is detected and treated during pregnancy, the mother and child benefit from pain control and recovery.

Medication-taking for secondary prevention of acute myocardial infarction: a thematic meta-synthesis of patient experiences.

OBJECTIVE: To collate existing qualitative research examining patients' medication-taking experiences in secondary prevention of acute myocardial infarction (AMI) and produce new knowledge, a systematic review and meta-synthesis of patient qualitative studies was conducted. METHOD: A systematic review found nine reports suitable for inclusion. Themes found by the report authors and report characteristic data were extracted. Reports were assessed for quality. A meta-synthesis using thematic coding and constant comparison method produced higher order themes, and these were used to construct a statement organised by theme using specific examples from the included studies. RESULTS: All patients discussed their medication-taking in thematic categories of beliefs about medication and illness, personal ability and interpersonal factors. Themes differed between classes of medication and between patients, suggesting tailored interventions to medications and individual patients would be appropriate. Some themes overlapped with those discussed by the broader group of cardiovascular patients, but some themes were unique to this myocardial infarction patient group, again indicating that a tailored approach is appropriate for this patient group. CONCLUSION: The themes of beliefs about medication and illness, personal ability and interpersonal support provide tangible starting points for addressing adherence issues. The concept of medication-taking had unique elements within the post-AMI group of patients, and between classes of medication. While these themes were grouped into more generalised higher-order constructs, there were differences between patients within the themed group, indicating that themes are useful as a guide, but individual-level patient support is appropriate.