The level of CAM use by Scottish breast cancer patients is similar to that reported from other countries, although there are marked differences in the type, nature and frequency of specific CAM therapies. Higher patient education level and use by family and friends were significantly associated with CAM use. The high level of use of potentially disease modifying or interacting herb supplements may be of concern.

BackgroundPregnant women are routinely prescribed medicines while self-medicating with herbal natural products to treat predominantly pregnancy related conditions. The aim of this study was to assess the potential for herb-drug interactions (HDIs) in pregnant women and to explore possible herb-drug interactions and their potential clinical significance.MethodsA cross-sectional survey of women during early pregnancy or immediately postpartum in North-East Scotland. Outcome measures included; Prescription medicines use excluding vitamins and potential HDIs assessed using Natural Medicines Comprehensive Database.ResultsThe survey was completed by 889 respondents (73% response rate). 45.3% (403) reported the use of at least one prescription medicine, excluding vitamins. Of those taking prescription medicines, 44.9% (181) also reported concurrent use of at least one HNP (Range 1–12). A total of 91 different prescription medicines were reported by respondents using HNPs. Of those taking prescription medicines, 44.9% (181) also reported concurrent use of at least one HNP (Range 1–12). Thirty-four herb-drug interactions were identified in 23 (12.7%) women with the potential to increase the risk of postpartum haemorrhage, alter maternal haemodynamics, and enhance maternal/fetal CNS depression.Almost all were rated as moderate (93.9%), one as a potentially major (ginger and nifedipine) and only one minor (ondansetron and chamomile).ConclusionAlmost half of pregnant women in this study were prescribed medicines excluding vitamins and minerals and almost half of these used HNPs. Potential moderate to severe HDIs were identified in an eighth of the study cohort. Healthcare professionals should be aware that the concurrent use of HNPs and prescription medicines during pregnancy is common and carries potential risks.

Background : Pregnant women who continue to smoke expose their developing fetus to a wide range of risks. Assisting these patients to stop smoking can be an important intervention for the health of the baby and the mother. The management of pregnant smokers can be challenging, due to the potential risks of pharmacotherapy. There are a number of options available to the clinician to aid smoking cessation in non pregnant women. These include nicotine replacement therapy (NRT), bupropion, varenicline, and a range of non-drug therapies. Objective : To provide guidance to prescribers on the best way to manage smoking cessation in the pregnant patient, reviewing the risks and efficacy of the different approaches. Methods : An extensive literature search was carried out to find original studies which examined issues surrounding the safety and efficacy of methods of smoking cessation in pregnancy. Results/conclusion : NRT is the agent of choice for smoking cessation in pregnancy as the safety of other therapies in pregnancy have not yet been proved.

BackgroundThe UK Medicines Information (UKMi) network is a ‘critical NHS resource’. Innes et al concluded, ‘the broadest cohort of healthcare professionals’ should have access to MI services. MI Centres (MICs) in Scotland provide enquiry answering services to primary and secondary care. There is under utilisation by general practitioners (GPs) in primary care.PurposeThe aims were to quantify and characterise enquiries at the study MIC from GPs, to compare this with other Scottish MICs and to investigate the views of GPs to the MIC services.Material and methodsFirstly, the number and types of enquiries received from GPs, from January 2016 to June 2016, were obtained from the local MIC database using a standardised data collection tool. The lead pharmacists at five similarly sized Scottish MICs were contacted by email to request information from their databases using the same tool. Secondly, a postal questionnaire was developed from the literature and a rigorous process of consultation with relevant experts. The questionnaire contained items on awareness, experiences and views of the MIC. It was piloted and sent in August 2016, with return envelope, to all GPs within the MIC’s catchment area (n=574), after excluding a pilot sample (n=64). A reminder questionnaire was posted 2 weeks later. Data were analysed using descriptive statistics. All appropriate ethical and NHS Research and Development approvals were obtained.ResultsOf the total enquiries received to the MIC, 55 (4.5%) were from GPs. This was similar to GP usage of most other MICs in Scotland. 193 questionnaire responses (34.3%) were received from GPs. The majority (n=126, 65.3%) were unaware of the MIC. Of those who had contacted the MIC with an enquiry previously (n=35), all were satisfied with the response(s) received. Of the total number of respondents, the majority (n=172, 89.1%) thought access to the MIC would be useful when prescribing medicines.ConclusionThe low response rate limits generalisability but result are similar to previous studies in the rest of the UK. MICs should consider actively promoting enquiry answering service to GPs to ensure equity of care across sectors. Further work to consider this across Europe would be warranted.No conflict of interest