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Background The aim of this study was to determine the prevalence of preoperative polypharmacy and the incidence of postoperative polypharmacy/hyper-polypharmacy in surgical patients and their association with adverse outcomes. Methods This was a retrospective, population-based cohort study among patients older than or equal to 18 years undergoing surgery at a university hospital between 2005 and 2018. Patients were categorized based on the number of medications: non-polypharmacy (fewer than 5); polypharmacy (5–9); and hyper-polypharmacy (greater than or equal to 10). The 30-day mortality, prolonged hospitalization (greater than or equal to 10 days), and incidence of readmission were compared between medication-use categories. Results Among 55 997 patients, the prevalence of preoperative polypharmacy was 32.3 per cent (95 per cent c.i. 33.5 to 34.3) and the prevalence of hyper-polypharmacy was 25.5 per cent (95 per cent c.i. 25.2 to 25.9). Thirty-day mortality was higher for patients exposed to preoperative hyper-polypharmacy (2.3 per cent) and preoperative polypharmacy (0.8 per cent) compared with those exposed to non-polypharmacy (0.6 per cent) (P < 0.001). The hazards ratio (HR) of long-term mortality was higher for patients exposed to hyper-polypharmacy (HR 1.32 (95 per cent c.i. 1.25 to 1.40)) and polypharmacy (HR 1.07 (95 per cent c.i. 1.01 to 1.14)) after adjustment for patient and procedural variables. The incidence of longer hospitalization (greater than or equal to 10 days) was higher for hyper-polypharmacy (11.3 per cent) and polypharmacy (6.3 per cent) compared with non-polypharmacy (4.1 per cent) (P < 0.001). The 30-day incidence of readmission was higher for patients exposed to hyper-polypharmacy (10.2 per cent) compared with polypharmacy (6.1 per cent) and non-polypharmacy (4.8 per cent) (P < 0.001). Among patients not exposed to polypharmacy, the incidence of new postoperative polypharmacy/hyper-polypharmacy was 33.4 per cent (95 per cent c.i. 32.8 to 34.1), and, for patients exposed to preoperative polypharmacy, the incidence of postoperative hyper-polypharmacy was 16.3 per cent (95 per cent c.i. 16.0 to 16.7). Conclusion Preoperative polypharmacy and new postoperative polypharmacy/hyper-polypharmacy are common and associated with adverse outcomes. This highlights the need for increased emphasis on optimizing medication usage throughout the perioperative interval. Registration number NCT04805151 (http://clinicaltrials.gov).

Aim: To explore the expectations of Icelandic community pharmacists and final year pharmacy students on future role extensions and associated education needs. Methods: All community pharmacists across Iceland registered with the Pharmaceutical Society of Iceland (LFI) (n=136) and all fourth- and fifth-year pharmacy students enrolled at the Faculty of Pharmaceutical Sciences at the University of Iceland (n=69). An online cross-sectional questionnaire was designed, validated, piloted and analysed using descriptive statistics, logistic regression and content analysis. Results: The response rate was 27.9% (n=38) for community pharmacists and 33.3% (n=23) for fourth- and fifth-year pharmacy students respectively. Of these, 90.2% (n=55) saw the need for community pharmacists’ role extensions and most (n=60, 98.4%) were willing to accept additional education to make role extensions in Iceland possible. Logistic regression identified that students identified the need for pharmacists to be making prescribing recommendations to medical healthcare professionals (p=0.023); for example “Pharmacists should use their knowledge to give advice and collaborate with physicians and other healthcare professionals about drug therapies”. Conclusion: Both community pharmacists and pharmacy students showed a strong willingness to extend their roles in the future. It will require government support to overcome perceived barriers and to develop further education programmes.

Introduction Evidence-based information regarding the use of medication during pregnancy is lacking, even though the use of medication during pregnancy is considered common and often neccesary. The aim of this study was to obtain reliable information on the use of medications during the first 20 weeks of pregnancy and the use of vitamins, minerals, fatty acids, herbs and other natural products. Women´s attitude and beliefs towards the use of medications was also examined. Material and methods The study was conducted at the Prenatal Diagnosis Unit at Landspitali from January to April 2017. Women who attended routine ultrasound examination at 20 weeks were offered to participate. A questionnaire was submitted to partici-pants in an interview with the researcher following the doctor's appointment. Results Of the 213 participants, 90% used medication at least once during the first 20 weeks of pregnancy. Approximately 80% of these medications belong to FASS safety classes A and B and are considered safe during pregnancy. The proportion of women who did not use folic acid was 14% which was associated with residence in rural areas (p=0.03) and younger age (p=0.019). Natural products were used by 14% but information about their safety is lacking. The majority (81%) was satisfied with the information they received when a drug was prescribed and 94% said they had sufficient access to information about medication use during pregnancy. The most commonly used sources of information were the internet (51%) and the local midwive (44%). Conclusion The use of medications and supplements during pregnancy is common. Most medications being used are considered safe during pregnancy. The majority of pregnant women take folic acid. Pregnant women have a logical and generally a positive attitude towards medication use during pregnancy.

Background Falsely labelled, falsified (counterfeit) medicines (FFCm’s) are produced or distributed illegally and can harm patients. Although the occurrence of FFCm’s is increasing in Europe, harm is rarely reported. The European Directorate for the Quality of Medicines & Health-Care (EDQM) has therefore coordinated the development and validation of a screening tool. Methods The tool consists of a questionnaire referring to a watch-list of FFCm’s identified in Europe, including symptoms of their use and individual risk factors, and a scoring form. To refine the questionnaire and reference method, a pilot-study was performed in 105 self-reported users of watch-list medicines. Subsequently, the tool was validated under “real-life conditions” in 371 patients in 5 ambulatory and in-patient care sites (“sub-studies”). The physicians participating in the study scored the patients and classified their risk of harm as “unlikely” or “probable” (cut-off level: presence of ≥2 of 5 risk factors). They assessed all medical records retrospectively (independent reference method) to validate the risk classification and documented their perception of the tool’s value. Results In 3 ambulatory care sites (180 patients), the tool correctly classified 5 patients as harmed by FFCm’s. The positive and negative likelihood ratios (LR+/LR-) and the discrimination power were calculated for two cut-off levels: a) 1 site (50 patients): presence of two risk factors (at 10% estimated health care system contamination with FFCm’s): LR + 4.9/LR-0, post-test probability: 35%; b) 2 sites (130 patients): presence of three risk factors (at 5% estimated prevalence of use of non-prescribed medicines (FFCm’s) by certain risk groups): LR + 9.7/LR-0, post-test probability: 33%. In 2 in-patient care sites (191 patients), no patient was confirmed as harmed by FFCm’s. The physicians perceived the tool as valuable for finding harm, and as an information source regarding risk factors. Conclusions This “decision aid” is a systematic tool which helps find in medical practice patients harmed by FFCm’s. This study supports its value in ambulatory care in regions with health care system contamination and in certain risk groups. The establishment of systematic communication between authorities and the medical community concerning FFCm’s, current patterns of use and case reports may sustain positive public health impacts. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2235-y) contains supplementary material, which is available to authorized users.