Background Although there are numerous legal and regulated online pharmacies available on the internet, an abundance of illegitimate online pharmacies are offering medications without prescriptions and deliver products with unknown origins worldwide. Despite the fact that the problem has gained the attention of regulatory and health organisations, the awareness of patients and many healthcare professionals is relatively low. Objectives The purpose of this work is to assess the current situation of ordering medicines online, to survey the attitude of patients regarding online drug purchase, promoting the completion of the medication history worksheet and to recommend useful tools for hospital pharmacists to facilitate online medication safety. Methods The attitude of 422 patients regarding purchasing drugs online was evaluated in a hospital environment. Results 8.4% of Hungarian hospital patients have ordered drugs or dietary supplements online and 3.7% of the respondents are considering this option in the future. Most hospital patients (82.8%) are unaware of the quality of these products. Conclusions Patients are not fully aware of the risks of potential hazards associated with purchasing medicines online and presumably cannot differentiate between legal and illegal online pharmacies. Illegal and counterfeit medicines pose a serious public health risk because the origin and quality of these drugs are uncertain and patients typically take these preparations without the knowledge and supervision of physicians or pharmacists. Pharmacists can play an essential role in protecting patient safety and combating counterfeit medicines.

IntroductionAcute pancreatitis (AP) is an inflammatory disease with no specific treatment. Mitochondrial injury followed by ATP depletion in both acinar and ductal cells is a recently discovered early event in its pathogenesis. Importantly, preclinical research has shown that intracellular ATP delivery restores the physiological function of the cells and protects from cell injury, suggesting that restoration of energy levels in the pancreas is therapeutically beneficial. Despite several high quality experimental observations in this area, no randomised trials have been conducted to date to address the requirements for energy intake in the early phase of AP.Methods/designThis is a randomised controlled two-arm double-blind multicentre trial. Patients with AP will be randomly assigned to groups A (30 kcal/kg/day energy administration starting within 24 hours of hospital admission) or B (low energy administration during the first 72 hours of hospital admission). Energy will be delivered by nasoenteric tube feeding with additional intravenous glucose supplementation or total parenteral nutrition if necessary. A combination of multiorgan failure for more than 48 hours and mortality is defined as the primary endpoint, whereas several secondary endpoints such as length of hospitalisation or pain will be determined to elucidate more detailed differences between the groups. The general feasibility, safety and quality checks required for high quality evidence will be adhered to.Ethics and disseminationThe study has been approved by the relevant organisation, the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (55961-2/2016/EKU). This study will provide evidence as to whether early high energy nutritional support is beneficial in the clinical management of AP. The results of this trial will be published in an open access way and disseminated among medical doctors.Trial registrationThe trial has been registered at the ISRCTN (ISRTCN 63827758).

A significant number of patients are exposed to potential drug interactions with supplementary products; however interagreement among interaction databases is poor. Our data suggest that a full medication history should specifically address the intake of supplements.

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Background In the last decade it has become a challenging problem for the pharmaceutical profession that alongside their prescribed drug treatment patients take supplementary products (OTC, herbal remedies, food supplements, ‘panacea’ etc.) without consulting their physician or pharmacist. The authors propose clinical pharmacists gather detailed information about drugs, additional remedies and their procurement sources, as interactions with medicines may harm health, decrease efficacy of the medical treatment and reduce patient compliance. Purpose Our study aims at exploring and analysing interactions between drugs and additional remedies among inpatients and outpatients at departments of internal medicine. This is a pilot study to confirm the practical applicability of our interaction monitoring system, which the authors plan to introduce at the clinic. Materials and methods A database has been developed by our department in collaboration with HC Pointer Ltd., which contains all the authorised or notified paramedicines and food supplements having a noteworthy market in Hungary. Screening is based on the evaluation of 155 components with potential for interactions, the synonyms of which give us a total of 3184 entries to be searched. Patient interviews and review of the medical records were performed by clinical pharmacists. The authors have gained information regarding current medication and additional remedies, past medical history, immunisation status and known allergies with the aid of a medication history worksheet. Results The authors have surveyed 98 patients so far, 58 of them (59,2%) have reported use of supplementary products (OTC, vitamins, herbal products, homeopathic remedies) along with their prescribed medicines. Potential interactions have been identified in seven cases (7,1%). Antithrombotic and antidiabetic agents were most commonly involved in interactions. Conclusions Gathering detailed information about the use of supplementary products should be included in medical histories in clinical pharmaceutical practice. Documentation and evaluation of interactions between herbal products and prescribed drugs can prevent adverse reactions and introduce higher standards for patient care. Special software and databases are indispensable due to the complexity of possible interactions.