Läkare, sjuksköterskor, farmaceuter, patienter och patienters anhöriga är alla delar av den kedja som ska se till så att läkemedelsanvändning sker på ett säkert sätt. Så många inblandade och i så många olika sammanhang gör att läkemedelsanvändning kan vara svårt att hantera. 2014 skrevs det ut 102 913 130 recept i Sverige (1). Fram till 2014 hade ca 850 000 felaktiga recept korrigerats av farmaceuter varje år (2). Att korrigera recept är en nödvändig del som ingår i farmaceutens skyldighet och ansvar vilket regleras i svensk lagstiftning (3). Farmaceuten är en del av vårdkedjan som skall tillse att patienten har en korrekt och säker behandling med läkemedel (4). Tillgång till en nationell gemensam läkemedelslista för alla berörda parter, förskrivare, farmaceut, patient och övrig vårdpersonal skulle kanske kunna komma tillrätta med felaktigheter i förskrivningar och därmed öka patientsäkerheten (4). Tidigare studier har genomförts som behandlar läkarens syn på en gemensam lista och även patientens syn på eHälsoarbete vilket till viss del belyser en gemensam lista (5)(6) men inga studier har hittats om hur en gemensam lista kommer att påverka farmaceuternas vardag vilket ett av syftena med detta arbete har varit. För att uppnå syftet genomfördes en enkätundersökning med farmaceuter verksamma på ett antal apotek där de fick delge sina tankar både kring den information om patienters aktuella läkemedel som finns tillgänglig idag, bland annat genom receptdepån och sina tankar kring en nationell gemensam läkemedelslista. Resultat av undersökning gör gällande att det förekommer fel i receptdepån både med avseende på saknad information, felaktigheter i recept och att recept förekommer mer än en gång och att de finns med trots att patienten inte skall använda dem mer. Majoriteten av farmaceuterna var eniga om att en nationell gemensam läkemedelslista skulle hjälpa dem i deras arbete för att öka patientsäkerheten men huruvida den kommer att lösa alla problem som förekommer i receptdepån får framtiden utvisa. / Doctors, nurses, pharmacists, patients and next of kin are all parts of the chain that is needed to make sure that the use of medication is safe and appropriate for the patient. That many people involved and in many different settings can make the use of medication difficult to manage. In the year 2014 there were 102 913 130 prescriptions made out to patients in Sweden. Up to the year 2014 850 000 corrections had been made to prescriptions with faults in them by pharmacists each year. To correct prescriptions is an essential part of the pharmacist’s obligations and responsibility, a responsibility that is regulated in Swedish law. The pharmacist is the last part of the chain that has the possibility to adjust anything that is wrong with medications and the use of it before it is in the patient’s own hands. The access to a nationally shared medication list for all involved parties might solve some of the problems that faces the responsible parties when it comes to dealing with patients and their new and ongoing medications and in that way be able to increase the safety around mediation for the patient in need. Although the survey conducted as part of this paper focuses on pharmacists the background tries to explain in what way the different professions come in contact with medicines and how they would perhaps benefit from a shared list. The paper also tries to give a little insight to what kind of problems there could be related to prescriptions. In Sweden we have come a rather long way in the use of computers and the use of internet in the field of eHealth compared to other countries. The paper tries to show how the problem surrounding prescription of medicine is handled in the other countries of Scandinavia. Earlier studies have been conducted that looks at shared lists from the doctors view and also studies have been conducted that looks upon eHealth for patients partly in view of shared medication lists. No studies have been found that looks specifically at how pharmacists feel about it and how such a list would benefit them in their work to secure patient safety, hence this paper. In order to reach the papers purpose a survey was performed with pharmacists employed at different pharmacies in the southern part of Sweden. The result of the survey showed that there are indeed problems with prescriptions in the prescription repository and the majority of the pharmacists agreed that a shared medication list could help them in their work to secure patient safety when releasing prescribed medication. Although the pharmacist agreed for the most part in the benefits of such a list they did not know if it would solve all problems, which is for the future to decide.

A indústria farmacêutica acarreta a geração de uma quantidade significante de resíduos potencialmente poluidores. Ao serem lançados em corpos d\'água, os efluentes das indústrias farmacêuticas provocam desequilíbrio no ambiente, por transportarem compostos de difícil degradação. A ocorrência desses resíduos no ambiente pode favorecer a resistência de microrganismos frente a esses fármacos, além de causar problemas de ordem toxicológica a determinados organismos vivos. No intuito de minimizar os impactos causados pelos despejos dos efluentes desta atividade industrial, torna-se necessário estudar tratamentos alternativos para degradação de tais resíduos. Esta pesquisa teve como proposta avaliar um Processo Oxidativo Avançado: Ozonição Catalítica Homogênea em presença de íons Fe2+ como técnica para tratamento de efluente veterinário, para tanto foram estudados três diferentes reatores em sistema contínuo. Na primeira etapa do estudo, foi definido o modelo de reator mais adequado para o tratamento desse efluente farmacêutico veterinário. Na segunda etapa do estudo, utilizou-se um planejamento fatorial fracionado 24-1 para otimizar as variáveis do processo: pH, concentração de Fe2+ g/L, potência do ozonizador (vazão mássica de O3) e vazão de saída do efluente do reator. A eficiência do tratamento foi avaliada por meio da redução de Carbono Orgânico Total (COT) (%). Este estudo mostrou que a condição experimental na qual se observou a maior porcentagem de redução de COT (46,14%) ocorreu quando se combinou pH 4,0, [Fe2+] de 0,5 g/L, vazão de saída do reator de 1,23 L/h e potência do ozonizador de 56W. A avaliação estatística desse planejamento apontou para uma nova configuração experimental na qual se obteve 55,24% de redução de COT, degradação do ativo Fenbendazol de 71,24% e degradação do ativo Triclabendazol de 95,68%. Essa nova configuração combinou pH 4,0, [Fe2+] de 0,1g/L, vazão de saída do reator de 1,85 L/h e potência de 56W. / The pharmaceutical industry generates a significant amount of potentially polluting waste. When released into stream, the pharmaceutical effluents cause imbalance in the environment, transporting compounds are difficult to degrade. The occurrence of these residues in the environment can improve the microbial resistance of these drugs and cause toxicological implication of certain organisms. In order to minimize the impacts caused by discharges of effluents of this industrial activity, it is necessary to study alternative treatments for degradation of the waste. The purpose of this work was to evaluate proposed system using continuous reactors as one treatment technique Advanced Oxidative Process: Catalytic Homogeneous Ozonization with Fe2+. In the first stage of the study, the reactor model more suitable for treatment of this veterinary pharmaceutical effluent. In the second stage of the study, used a design factorial 24-1to optimize the variables of the process: pH, concentration of Fe2+ g/L, ozoniser power and output flow reactor. The efficiency of the treatment was evaluated by the reduction of Total Organic Carbon rate (TOC) (%). This study showed that the experimental condition in which it was observed the highest percentage of TOC reduction (46.14%) occurred when combined pH 4.0, [Fe 2 +] 0.5 g / L, the output flow reactor 1.23 L / h and ozoniser power of 56W. The statistical evaluation of this planning pointed to a new experimental setup in which we obtained 55.24% reduction of TOC, degradation of drug Fenbendazole 71.24% and degradation of 95.68% drug Triclabendazole. This new configuration combined pH 4.0, [Fe 2 +] of 0.1 g / L, output flow reactor of 1.85 L / h and ozoniser power of 56W.

A ocorrência de fármacos no meio ambiente tem se tornado um assunto de interesse nos últimos anos. A preocupação com a presença de produtos farmacêuticos decorre de sua persistência química, resistência microbiana, e efeitos sinérgicos, que levam às implicações toxicológicas. O objetivo deste trabalho foi avaliar o tratamento do efluente farmacêutico endoparasiticida. Para isso, os processos Fenton e Foto-Fenton foram usados para se obter a redução da carga orgânica do efluente em questão. Para a caracterização analítica do efluente farmacêutico in natura e tratado foram empregados métodos estabelecidos e otimizados, tais como DQO, COT, DBO5, Ferro, Sólidos (ST, STF, STV), fenol e análise de elementos via absorção atômica. Por meio de dois arranjos ortogonais - Taguchi L9 e Taguchi L16 - os parâmetros de melhor eficiência para o tratamento por Fenton e Foto-Fenton foram determinados. A matriz L9 foi utilizada para estudo exploratório dos fatores mais importantes na redução percentual da DQO. Este estudo mostrou que a condição experimental na qual se observou a maior porcentagem de redução de DQO (da ordem de 86,2 %) no efluente farmacêutico foi o experimento com reagente Fenton igual a 31,7g H2O2 e 2,2 g Fe2+, sem radiação ultravioleta, pH igual a 3,0 e temperatura de 30 °C. Já com a matriz L16 foram determinados os melhores experimentos, tendo como fatores resposta o percentual de redução do COT e percentual de degradação dos princípios ativos Fenbendazol e Triclabendazol. Portanto, a melhor configuração dos fatores foi Temperatura de 20°C, massa de H2O2 igual a 30 g, massa de Fe2+ igual a 2,5 g, pH igual a 3,0 e potência de radiação ultravioleta de 28 W, ou seja, a configuração que apresentou as maiores porcentagens de redução do COT (da ordem de 73,6%), degradação do Fenbendazol (da ordem de 77,8 %) e degradação do Triclabendazol (da ordem de 91,5 %). / The occurence of the drugs in the environment has become a subject of interest in the latest years. The concern with the presence of pharmaceutical products comes from its chemical persistence, microbial resistence and synergistic effects which lead to toxicological implications. The objective of this work was to evaluate of the treatment of endoparasiticide pharmaceutical effluent. For that, the photo-Fenton and Fenton were used for achieving the reduction of the organic load of the effluent in question. For the analytical characterization of pharmaceutical effluent in natura and treated were employed methods established and optimized such as DQO, COT, TOC, DBO5, Iron, Solid ( ST, STV, STF), phenol and element analysis via atomic absorption. By means of two orthogonal arrangements - Taguchi L9 and L16 - parameters of better efficiency in the treatment by Photo-Fenton and Fenton were determined. The L9 matrix was used for exploratory study of the most important factors in reducing the percentage of DQO. This study showed that the experimental condition, in which it was observed the highest percentage reduction of DQO (approximately 86.2%) in the pharmacist effluent, was the experiment with Fenton\'s reagent equal to 31,7g H2O2 e 2,2 g Fe2+, without ultraviolet radiation, pH equal to 3.0 and a temperature of 30 ° C. With the L16 matrix were determined as the best experiment with response factors the percentage reduction of COT and percentage of degradation of the active Fenbendazole and Triclabendazole. Therefore, the best configuration of the factors was 20 º C, H2O2 mass equal to 30g, Fe2 + mass of 2.5 g, and pH equal to 3.0 and power of 28W ultraviolet radiation, in other words the configuration that had the greatest percentage reduction of COT ( the order of 73.6%), Fenbendazole degradation (the order of 77.8%) and degradation Triclabendazole (the order of 91.5%).

A indústria farmacêutica acarreta a geração de uma quantidade significante de resíduos potencialmente poluidores. Ao serem lançados em corpos d\'água, os efluentes das indústrias farmacêuticas provocam desequilíbrio no ambiente, por transportarem compostos de difícil degradação. A ocorrência desses resíduos no ambiente pode favorecer a resistência de microrganismos frente a esses fármacos, além de causar problemas de ordem toxicológica a determinados organismos vivos. No intuito de minimizar os impactos causados pelos despejos dos efluentes desta atividade industrial, torna-se necessário estudar tratamentos alternativos para degradação de tais resíduos. Esta pesquisa teve como proposta avaliar um Processo Oxidativo Avançado: Ozonição Catalítica Homogênea em presença de íons Fe2+ como técnica para tratamento de efluente veterinário, para tanto foram estudados três diferentes reatores em sistema contínuo. Na primeira etapa do estudo, foi definido o modelo de reator mais adequado para o tratamento desse efluente farmacêutico veterinário. Na segunda etapa do estudo, utilizou-se um planejamento fatorial fracionado 24-1 para otimizar as variáveis do processo: pH, concentração de Fe2+ g/L, potência do ozonizador (vazão mássica de O3) e vazão de saída do efluente do reator. A eficiência do tratamento foi avaliada por meio da redução de Carbono Orgânico Total (COT) (%). Este estudo mostrou que a condição experimental na qual se observou a maior porcentagem de redução de COT (46,14%) ocorreu quando se combinou pH 4,0, [Fe2+] de 0,5 g/L, vazão de saída do reator de 1,23 L/h e potência do ozonizador de 56W. A avaliação estatística desse planejamento apontou para uma nova configuração experimental na qual se obteve 55,24% de redução de COT, degradação do ativo Fenbendazol de 71,24% e degradação do ativo Triclabendazol de 95,68%. Essa nova configuração combinou pH 4,0, [Fe2+] de 0,1g/L, vazão de saída do reator de 1,85 L/h e potência de 56W. / The pharmaceutical industry generates a significant amount of potentially polluting waste. When released into stream, the pharmaceutical effluents cause imbalance in the environment, transporting compounds are difficult to degrade. The occurrence of these residues in the environment can improve the microbial resistance of these drugs and cause toxicological implication of certain organisms. In order to minimize the impacts caused by discharges of effluents of this industrial activity, it is necessary to study alternative treatments for degradation of the waste. The purpose of this work was to evaluate proposed system using continuous reactors as one treatment technique Advanced Oxidative Process: Catalytic Homogeneous Ozonization with Fe2+. In the first stage of the study, the reactor model more suitable for treatment of this veterinary pharmaceutical effluent. In the second stage of the study, used a design factorial 24-1to optimize the variables of the process: pH, concentration of Fe2+ g/L, ozoniser power and output flow reactor. The efficiency of the treatment was evaluated by the reduction of Total Organic Carbon rate (TOC) (%). This study showed that the experimental condition in which it was observed the highest percentage of TOC reduction (46.14%) occurred when combined pH 4.0, [Fe 2 +] 0.5 g / L, the output flow reactor 1.23 L / h and ozoniser power of 56W. The statistical evaluation of this planning pointed to a new experimental setup in which we obtained 55.24% reduction of TOC, degradation of drug Fenbendazole 71.24% and degradation of 95.68% drug Triclabendazole. This new configuration combined pH 4.0, [Fe 2 +] of 0.1 g / L, output flow reactor of 1.85 L / h and ozoniser power of 56W.

A ocorrência de fármacos no meio ambiente tem se tornado um assunto de interesse nos últimos anos. A preocupação com a presença de produtos farmacêuticos decorre de sua persistência química, resistência microbiana, e efeitos sinérgicos, que levam às implicações toxicológicas. O objetivo deste trabalho foi avaliar o tratamento do efluente farmacêutico endoparasiticida. Para isso, os processos Fenton e Foto-Fenton foram usados para se obter a redução da carga orgânica do efluente em questão. Para a caracterização analítica do efluente farmacêutico in natura e tratado foram empregados métodos estabelecidos e otimizados, tais como DQO, COT, DBO5, Ferro, Sólidos (ST, STF, STV), fenol e análise de elementos via absorção atômica. Por meio de dois arranjos ortogonais - Taguchi L9 e Taguchi L16 - os parâmetros de melhor eficiência para o tratamento por Fenton e Foto-Fenton foram determinados. A matriz L9 foi utilizada para estudo exploratório dos fatores mais importantes na redução percentual da DQO. Este estudo mostrou que a condição experimental na qual se observou a maior porcentagem de redução de DQO (da ordem de 86,2 %) no efluente farmacêutico foi o experimento com reagente Fenton igual a 31,7g H2O2 e 2,2 g Fe2+, sem radiação ultravioleta, pH igual a 3,0 e temperatura de 30 °C. Já com a matriz L16 foram determinados os melhores experimentos, tendo como fatores resposta o percentual de redução do COT e percentual de degradação dos princípios ativos Fenbendazol e Triclabendazol. Portanto, a melhor configuração dos fatores foi Temperatura de 20°C, massa de H2O2 igual a 30 g, massa de Fe2+ igual a 2,5 g, pH igual a 3,0 e potência de radiação ultravioleta de 28 W, ou seja, a configuração que apresentou as maiores porcentagens de redução do COT (da ordem de 73,6%), degradação do Fenbendazol (da ordem de 77,8 %) e degradação do Triclabendazol (da ordem de 91,5 %). / The occurence of the drugs in the environment has become a subject of interest in the latest years. The concern with the presence of pharmaceutical products comes from its chemical persistence, microbial resistence and synergistic effects which lead to toxicological implications. The objective of this work was to evaluate of the treatment of endoparasiticide pharmaceutical effluent. For that, the photo-Fenton and Fenton were used for achieving the reduction of the organic load of the effluent in question. For the analytical characterization of pharmaceutical effluent in natura and treated were employed methods established and optimized such as DQO, COT, TOC, DBO5, Iron, Solid ( ST, STV, STF), phenol and element analysis via atomic absorption. By means of two orthogonal arrangements - Taguchi L9 and L16 - parameters of better efficiency in the treatment by Photo-Fenton and Fenton were determined. The L9 matrix was used for exploratory study of the most important factors in reducing the percentage of DQO. This study showed that the experimental condition, in which it was observed the highest percentage reduction of DQO (approximately 86.2%) in the pharmacist effluent, was the experiment with Fenton\'s reagent equal to 31,7g H2O2 e 2,2 g Fe2+, without ultraviolet radiation, pH equal to 3.0 and a temperature of 30 ° C. With the L16 matrix were determined as the best experiment with response factors the percentage reduction of COT and percentage of degradation of the active Fenbendazole and Triclabendazole. Therefore, the best configuration of the factors was 20 º C, H2O2 mass equal to 30g, Fe2 + mass of 2.5 g, and pH equal to 3.0 and power of 28W ultraviolet radiation, in other words the configuration that had the greatest percentage reduction of COT ( the order of 73.6%), Fenbendazole degradation (the order of 77.8%) and degradation Triclabendazole (the order of 91.5%).

Abstract available through Journal of the American Pharmacists Association.

This presentation describes (1) the role of communication in prescription drug abuse prevention and treatment and (2) the outcomes of 5 focus groups conducted in the Appalachian Region.

Background Maternal opioid use and neonatal abstinence syndrome (NAS) incidence have increased markedly in the US in recent years. Objectives (1) To assess prescribers’ and community pharmacists’ guideline-based NAS prevention behaviors; (2) to describe providers’ perceptions of contraceptive appropriateness in female patients of childbearing age. Method Cross-sectional study of 100 randomly selected primary care physicians, 100 prescribers authorized to engage in in-office treatment of opioid use disorders with buprenorphine, 100 pain management clinic directors, and 100 community pharmacists in Tennessee (N = 400 providers total) to evaluate self-reported engagement in 15 NAS prevention behaviors and perceived appropriateness of 8 contraceptive methods in opioid using women of childbearing age. Results An overall response rate of 17.5% was obtained. Pain clinic directors reported the most engagement in NAS prevention, engaging 80% or more of female patients of childbearing age prescribed an opioid in 11 prevention behaviors, followed by buprenorphine prescribers (8 behaviors), primary care physicians (5 behaviors), and community pharmacists (2 behaviors). Pain clinic directors, primary care physicians, and community pharmacists perceived oral contraceptive pills and patches to be as appropriate as long-acting, reversible forms of contraception (e.g., implants, injectable depots, intrauterine devices). Conclusion Provider engagement in behaviors that could prevent NAS is variable. Interventions should be implemented that equip providers to engage patients in conversations about long-acting, reversible contraception.

Background: Prescribers and community pharmacists commonly perceive prescription opioid abuse to be a problem in their practice settings and communities. Both cohorts have expressed support for interventions that improve interprofessional communication and reduce prescription opioid abuse. The objective of this study was to describe prescription opioid abuse-related communication among and between prescribers and community pharmacists in South Central Appalachia. Methods: The investigators conducted five focus groups with 35 Appalachian Research Network practice-based research network providers between February and October, 2014. Two prescriber-specific, two pharmacist-specific, and one interprofessional (prescribers and pharmacists) focus groups were conducted, recorded, and transcribed. Data collection and analysis occurred iteratively. Emerging themes were inductively derived and refined. Five member-checking interviews were conducted to validate themes. Results: Providers noted several factors that influence intraprofessional and interprofessional communication, including level of trust, role perceptions, conflict history and avoidance, personal relationships, and prescription monitoring program use. Indirect communication approaches via patients, office staff, and voicemail systems were common. Direct pharmacist to prescriber and prescriber to pharmacist communication was described as rare and often perceived to be ineffective. Prescriber to pharmacist communication was reported by prescribers to have decreased after implementation of state prescription monitoring programs. Difficult or uncomfortable conversations were often avoided by providers. Conclusions: Interprofessional and intraprofessional prescription opioid abuse communication is situational and influenced by multiple factors. Indirect communication and communication avoidance are common. Themes identified in this study can inform development of interventions that improve providers' intra- and interprofessional communication skills.

Community pharmacists in the United States have significant opportunity to engage in community-level prescription substance abuse prevention and treatment efforts, including dissemination of information specific to available addiction treatment options. Our cross-sectional study of Tennessee community pharmacists noted that 26% had previously provided addiction treatment facility information to one or more patients in the past. The purpose of this study was to employ multivariate modeling techniques to investigate associations between community pharmacist and community pharmacy factors and past provision of addiction treatment information to pharmacy patients. Multivariate logistic regression indicated having addiction treatment facility information in a pharmacy setting (aOR=8.19; 95% CI=4.36–15.37), having high confidence in ability to discuss treatment facility options (aOR=4.16; 95% CI=2.65–6.52), having participated in prescription opioid abuse-specific continuing education (aOR=2.90; 95% CI=1.70–4.97), being male (aOR=2.23; 95% CI=1.38–3.59), and increased hours per week in the practice setting (aOR=1.02; 95% CI=1.004–1.05) were all significantly associated with provision of information about addiction treatment. Dissemination of addiction treatment information, improvements in communicative self-efficacy beliefs, and dissemination of prescription opioid abuse-specific continuing education are modifiable factors significantly associated with increased provision of addiction treatment information by community pharmacists.