Rhiannon Braund

TiO2-assisted photodegradation of pharmaceuticals — a review

AbstractPharmaceutical compounds have been detected in the environment and potentially arise from the discharge of excreted and improperly disposed medication from sewage treatment facilities. In order to minimize environmental exposure of pharmaceutical residues, a potential technique to remove pharmaceuticals from water is the use of an advanced oxidation process (AOP) involving titanium dioxide (TiO2) photocatalysis. To evaluate the extent UV/TiO2 processes have been studied for pharmaceutical degradation, a literature search using the keywords ‘titanium dioxide’, ‘photocatalysis’, ‘advanced oxidation processes’, ‘pharmaceuticals’ and ‘degradation’ were used in the ISI Web of Knowledge TM, Scopus TM and ScienceDirect TM databases up to and including articles published on 23 November 2011. The degradation rates of pharmaceuticals under UV/TiO2 treatment were dependent on type and amount of TiO2 loading, pharmaceutical concentration, the presence of electron acceptors and pH. Complete mineralization under particular experimental conditions were reported for some pharmaceuticals; however, some experiments reported evolution of toxic intermediates during the photocatalytic process. It is concluded that the UV/TiO2 system is potentially a feasible wastewater treatment process, but careful consideration of the treatment time, the loading and the type of TiO2 (doped vs. undoped) used for a particular pharmaceutical is necessary for a successful application (198 words).

Investigating unused medications in New Zealand

Objective The objectives of this study were to determine the reasons for returning medications unused and the types of unused medications returned based on therapeutic class. Setting: This study was conducted in a region of New Zealand covered by the Hutt Valley District Health Board. This region has approximately 51,000 households. Methods A ‘Disposal of Unwanted Medication Properly (DUMP)’ campaign was conducted for a four week period in November 2007 in the Hutt Valley DHB region. A collection bag was delivered to every household for the collection and disposal of any unused medications. Participants were instructed to return the bags to a community pharmacy. Those returning medications were also asked to complete a questionnaire to determine why the medications were not used. A sample of the returned medications was identified and quantified and every completed questionnaire was analysed. Main outcome measures: The main outcome measures included: types and quantities of medications returned, calculated costs of these medications and reasons for returns. Results Over the four week period, 1,605 bags were returned for disposal. A total of 329 bags (20%) containing a total of 1,253 items were fully analysed. Only 653 questionnaires were completed (41%) all of which were analysed. The most commonly reported reason for not using the medication was that it had passed the expiry date (26%), the second was treatment change (24%), followed by condition resolved (15%). ‘Alimentary tract & metabolism’ and ‘respiratory systems & allergies’ accounted for 21 and 20% of cost respectively. Conclusions This study found that main reasons identified for patients having unwanted medications were ‘treatment changes’ and ‘expired’. Additionally respiratory medications contributed 20% of the costs associated with unused medications.

Analysis of Medications Returned to Community Pharmacies

Background: There are many causes of medication waste, including excess supply, treatment changes, and patient nonadherence to therapy. Investigating medication returns may indicate areas for targeting interventions to reduce waste. Objective: To identify and quantify the types and amounts of medications returned to community pharmacies and, specifically, to quantify the percentage of medication returned from the original dispensing, its therapeutic category, and reasons for not being used. Methods: Unsolicited medication returned for disposal to the 24 community pharmacies in the Taranaki region (~ 37,000 households) of New Zealand over a 6-week period was analyzed. The results were entered into a database, recording medication, amount originally issued (if known), date of issue, Anatomical Therapeutic Chemical (ATC) classification, and reason for nonuse. Cross-tabulation of ATC category versus percentage returned as well as ATC category versus reason for returns was performed. Adjusted standardized residuals were investigated to determine specific cells that were in excess of the expected counts. Results: Complete information was available for 2704 items. The majority (51%) of returns contained 75–100% of the original dispensed amount of medication. For the respiratory category, 77% of the returns were in the 75–100% group, significantly more than for any other therapeutic group. Reasons for returns were recorded as bereavement (22%), surplus to requirements (17%), expired (8%), medication change (11%), dose change (3%), and unknown (39%). The cardiovascular group and respiratory groups had a higher rate of returned drugs due to medication changes and surplus to requirements, respectively. Conclusions: The majority of returned medications contained greater than 75% of the original amount issued. Identification of therapeutic groups having higher rates of returns due to medication changes or surplus to requirements may suggest areas to target to reduce medication waste.

Are all pharmacy staff interested in potential future roles

Objectives  To determine the current perceived roles and responsibilities of pharmacy staff in community pharmacies in New Zealand, and attitudes to proposed new advanced roles for pharmacy staff.

Recommending NSAIDs and paracetamol: A survey of New Zealand physiotherapists' knowledge and behaviours.

BACKGROUND  Clinical guidelines recommend medications as first line treatment for many musculoskeletal injuries. As first line health professionals for musculoskeletal conditions, including sprains and strains, physiotherapists may be asked to recommend suitable medications. Currently recommending medications is outside of the physiotherapists scope of practice. However there is evidence that physiotherapists often do recommend medications, mostly simple analgesics and non-steroidal anti-inflammatory drugs (NSAIDs).  PURPOSE  The aim of this study was to investigate the current knowledge and behaviour of New Zealand musculoskeletal physiotherapists regarding recommendation of non-prescription medications for the treatment of musculoskeletal sprains and strains. METHOD 2438 New Zealand physiotherapists were surveyed, of whom approximately 948 work in musculoskeletal physiotherapy. Results. Of 278 respondents (29.3% response rate), 213 (81.0%) sometimes or often recommend oral NSAIDs to patients, and 216 (82.1%) recommend oral paracetamol. Most respondents (225, 85.5%) report that they routinely provide information on potential side effects, 181 (68.8%) on potential risks. Many refer to a pharmacist, however 146 (55.5%) make recommendations on dose, and 119 (45.2%) recommend specific brand names. When asked what the risks associated with NSAIDs were, most respondents (>70%) were able to name at least gastrointestinal upset, ulcers or bleeding, while the proportion able to name respiratory, renal or allergic risks was lower (<31%).  CONCLUSION These data indicate that a large proportion of New Zealand musculoskeletal physiotherapists are practicing outside of the general scope of physiotherapy practice with regards recommending medicines to patients. While a large proportion have a good knowledge of potential side effects and risks, the knowledge is incomplete and inadequate for this practice.

UV-induced photodegradation of oseltamivir (Tamiflu) in water

Environmental context Oseltamivir (Tamiflu) is widely used to prevent and treat influenza but conventional wastewater processes involving sedimentation and biotic oxidation do not appear to significantly remove it from sewage, leading to its discharge into the environment. A range of advanced oxidation processes (AOPs) involving photolysis of aqueous solutions of oseltamivir with UV alone, UV/H2O2 and UV/H2O2/FeII is demonstrated to lead to photodegradation of oseltamivir to products with no ecotoxicity observed. These AOPs may therefore offer potentially environmentally friendly sewage water treatment options. Abstract Aqueous solutions of the antiviral drug oseltamivir phosphate (OSP, Tamiflu, (3R,4R,5S)-ethyl 4-acetamido-5-amino-3-(pentan-3-yloxy)cyclohex-1-enecarboxylate) were degraded using advanced oxidation processes (AOPs) involving photodegradation with UV alone, UV/H2O2 and UV/H2O2/FeII (photo-Fenton reaction). The photodecay of the parent OSP in all three cases followed first-order kinetics with respective rate constants of 0.21, 1.56 and 1.75 min–1 at 20°C in pH 7 phosphate-buffered Milli-Q water. The rate of UV/H2O2 photolysis in the presence of 2-methylpropan-2-ol was significantly slower with an approximate first-order rate constant of 0.13 min–1 suggesting the involvement of •OH in the degradation process. NMR spectroscopy, mass spectrometry and high-performance liquid chromatography (HPLC) with UV diode array detection were used to identify the crude photoproduct as the hydroxylated OSP derivative (3S,4R,5S)-ethyl 4-acetamido-5-amino-2-hydroxy-3-(pentan-3-yloxy)cyclohexanecarboxylate that occurs by an unknown mechanism. OSP and this crude photoproduct demonstrated no effect on the survival of Quinquelaophonte sp. over 96 h.

A model‐based meta‐analysis of the influence of factors that impact adherence to medications

Several studies have investigated factors that may influence adherence for a given disease. The influence of disease on adherence has received limited attention. Less work has been conducted to investigate the influence of other factors in conjunction with disease on adherence. The aim of this study was to determine the independent influence of disease and other factors on adherence.

Quantification of the Forgiveness of Drugs to Imperfect Adherence

The circumstance of how sensitive therapeutic success is under imperfect adherence is driven by the property known as forgiveness. To date, no studies have considered variability in the pharmacokinetic‐pharmacodynamic process in conjunction with imperfect adherence patterns in order to develop a comparative criterion to determine the forgiveness of a drug. In this study, we have proposed a criterion to quantify forgiveness; illustrated the criterion for a theoretical example and evaluated the forgiveness of a motivating example, namely warfarin. A forgiveness criterion, relative forgiveness, is defined as the number of times more likely that a target is successfully attained under perfect adherence compared to imperfect adherence; or when comparing two drugs under a standard setting of imperfect adherence. The relative forgiveness criterion may have important implications for both drug development and clinical practice since the choice of drug can account for the likely influence of its forgiveness.

Can they do it? Comparing the views of pharmacists and technicians to the introduction of an advanced technician role

This study aimed to investigate the opinions of pharmacists and technicians regarding the ability of New Zealand technicians to take on an advanced checking technician role.

Pharmacist-only trimethoprim: pharmacist satisfaction on their training and the impact on their practice

Background In 2012, in a first for the developed world, New Zealand reclassified trimethoprim to allow specially trained pharmacists to supply the medicine without a prescription to women with cystitis fitting specific criteria. Objective This study explored pharmacists’ views of the training and screening tool, impact on practice, and the pharmacists’ perceptions of views of patients and doctors. Methods Structured interviews were conducted with 28 New Zealand pharmacists trained to supply trimethoprim. These pharmacists were selected to represent geographical spread as well as urban, suburban and rural. The key areas for investigation were: satisfaction about training, appropriateness of training, opinions on the screening tool, impact on clinical practice and perception of others. Audio recorded interviews were thematically analyzed. Results Of 40 pharmacies invited, 28 pharmacists agreed to participate. Most pharmacists were positive about being able to supply trimethoprim, the training and increased clinical focus of their practice. The content of the training was considered appropriate, as was the screening tool, which was well utilised during consultations. Minor suggestions on the training and consultation materials were provided. Some pharmacists reported that referral to the doctor without supply in a minority of trimethoprim consultations, frustrated some women. Frequency of supplies varied considerably by pharmacists from none supplied to weekly supplies. Some pharmacists questioned the exclusion to supply for women who had taken antibiotics in the last six months. Many women had reportedly appreciated the easier access in the pharmacy compared with doctor access, especially at weekends, but sometimes misunderstood the role of the pharmacist in the supply. While pharmacists reported that some doctors had been negative about pharmacist-supply, others were informing women about the service from the pharmacist. Conclusion Pharmacist supply of trimethoprim using mandated training and a screening tool or algorithm for supply is workable and well-accepted by pharmacists. Minor changes have been recommended. Further research is needed to understand perspectives of other stakeholders (women, doctors and practice nurses) and outcomes for patients.